Provider Demographics
NPI:1013184134
Name:WORLD OF INDEPENDENCE, IN
Entity Type:Organization
Organization Name:WORLD OF INDEPENDENCE, IN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-422-1069
Mailing Address - Street 1:1804 S DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-4730
Mailing Address - Country:US
Mailing Address - Phone:407-422-1069
Mailing Address - Fax:407-420-1575
Practice Address - Street 1:1804 S DIVISION AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-4730
Practice Address - Country:US
Practice Address - Phone:407-422-1069
Practice Address - Fax:407-420-1575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMV50056OtherMOTOR VEHICLE REPAIR REGISTRATION CERTIFICATE
FL018-01-09OtherNATIONAL MOBILITY EQUIPMENT DEALERS ASSOC.