Provider Demographics
NPI:1285636373
Name:AUTOFARM MOBILITY,LLC
Entity Type:Organization
Organization Name:AUTOFARM MOBILITY,LLC
Other - Org Name:MCCROCKLIN MOBILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KISSLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-354-2261
Mailing Address - Street 1:810 W MILL ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47356-1028
Mailing Address - Country:US
Mailing Address - Phone:765-354-2261
Mailing Address - Fax:765-354-6604
Practice Address - Street 1:810 W MILL ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:IN
Practice Address - Zip Code:47356-1028
Practice Address - Country:US
Practice Address - Phone:765-354-2261
Practice Address - Fax:765-354-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN196751332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000281743OtherBCR PIN
IN200506680AMedicaid
IN200340460AMedicaid
IN4255740001Medicare NSC