Provider Demographics
NPI:1003931452
Name:MOBILITY DISTRIBUTING, INC.
Entity Type:Organization
Organization Name:MOBILITY DISTRIBUTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:MERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-929-1456
Mailing Address - Street 1:333 W BLAINE ST
Mailing Address - Street 2:
Mailing Address - City:MCADOO
Mailing Address - State:PA
Mailing Address - Zip Code:18237-1216
Mailing Address - Country:US
Mailing Address - Phone:570-929-1456
Mailing Address - Fax:570-929-1478
Practice Address - Street 1:333 W BLAINE ST
Practice Address - Street 2:
Practice Address - City:MCADOO
Practice Address - State:PA
Practice Address - Zip Code:18237-1216
Practice Address - Country:US
Practice Address - Phone:570-929-1456
Practice Address - Fax:570-929-1478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA54189132332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001001933-0002Medicaid