Provider Demographics
NPI:1164766267
Name:TYCON MOBILITY
Entity Type:Organization
Organization Name:TYCON MOBILITY
Other - Org Name:HAMPTON ROADS MOBILITY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-848-5884
Mailing Address - Street 1:658 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1837
Mailing Address - Country:US
Mailing Address - Phone:757-848-5884
Mailing Address - Fax:757-848-5917
Practice Address - Street 1:658 J CLYDE MORRIS BLVD STE A
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1837
Practice Address - Country:US
Practice Address - Phone:757-848-5884
Practice Address - Fax:757-848-5917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA317867-2012332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies