Provider Demographics
NPI:1154328979
Name:MAX MOBILITY INC
Entity Type:Organization
Organization Name:MAX MOBILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-441-5500
Mailing Address - Street 1:1345 QUEENS CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:ST PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-7356
Mailing Address - Country:US
Mailing Address - Phone:636-441-5500
Mailing Address - Fax:636-441-5525
Practice Address - Street 1:1345 QUEENS CT
Practice Address - Street 2:SUITE A
Practice Address - City:ST PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-7356
Practice Address - Country:US
Practice Address - Phone:636-441-5500
Practice Address - Fax:636-441-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies