Provider Demographics
NPI:1194817916
Name:GLASS SEATING AND MOBILITY
Entity Type:Organization
Organization Name:GLASS SEATING AND MOBILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:GLASS
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:ATS, ATP
Authorized Official - Phone:901-379-0096
Mailing Address - Street 1:1687 N SHELBY OAKS DR
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-7421
Mailing Address - Country:US
Mailing Address - Phone:901-379-0096
Mailing Address - Fax:901-379-0018
Practice Address - Street 1:1687 N SHELBY OAKS DR
Practice Address - Street 2:SUITE 9
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7421
Practice Address - Country:US
Practice Address - Phone:901-379-0096
Practice Address - Fax:901-379-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000805332B00000X, 332BC3200X
MS06285/11.1332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07089577Medicaid
TN1454612Medicaid
TN1454612Medicaid