Provider Demographics
NPI:1073514816
Name:FREEDOM MOBILITY, INC.
Entity Type:Organization
Organization Name:FREEDOM MOBILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:W
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-672-3592
Mailing Address - Street 1:1658 DEL RIO RD
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-9557
Mailing Address - Country:US
Mailing Address - Phone:541-672-3592
Mailing Address - Fax:541-672-4284
Practice Address - Street 1:2620 E BARNETT RD
Practice Address - Street 2:STE. K
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8383
Practice Address - Country:US
Practice Address - Phone:541-245-6199
Practice Address - Fax:541-672-4284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR230753Medicaid
OR710267OtherLIPA OHP HMO
OR230753Medicaid