Provider Demographics
NPI:1164417705
Name:THE MOBILITY STORE OF IOWA INC.
Entity Type:Organization
Organization Name:THE MOBILITY STORE OF IOWA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:PILK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-727-4923
Mailing Address - Street 1:4178 NW URBANDALE DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-7915
Mailing Address - Country:US
Mailing Address - Phone:515-727-4923
Mailing Address - Fax:515-727-4932
Practice Address - Street 1:4178 NW URBANDALE DR
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-7915
Practice Address - Country:US
Practice Address - Phone:515-727-4923
Practice Address - Fax:515-727-4932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0266395Medicaid
IA4507520001Medicare NSC