Provider Demographics
NPI:1033103023
Name:MOBILITY MEDICAL INC
Entity Type:Organization
Organization Name:MOBILITY MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANYELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-932-1001
Mailing Address - Street 1:554 PARK LN
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8895
Mailing Address - Country:US
Mailing Address - Phone:601-932-1001
Mailing Address - Fax:601-932-2130
Practice Address - Street 1:554 PARK LN
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8895
Practice Address - Country:US
Practice Address - Phone:601-932-1001
Practice Address - Fax:601-932-2130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12380332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440843Medicaid
MS00440843Medicaid