Provider Demographics
NPI:1922007970
Name:MEDICAL MOBILITY INC
Entity type:Organization
Organization Name:MEDICAL MOBILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-490-8485
Mailing Address - Street 1:10020 LIMA RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-9144
Mailing Address - Country:US
Mailing Address - Phone:260-490-8485
Mailing Address - Fax:260-490-9874
Practice Address - Street 1:10020 LIMA RD
Practice Address - Street 2:SUITE D
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-9144
Practice Address - Country:US
Practice Address - Phone:260-490-8485
Practice Address - Fax:260-490-9874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN4811410001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4811410001Medicare ID - Type UnspecifiedPROVIDER NUMBER