Provider Demographics
NPI:1376647446
Name:PETERSON MOBILITY
Entity Type:Organization
Organization Name:PETERSON MOBILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-621-9663
Mailing Address - Street 1:103 1ST ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-2712
Mailing Address - Country:US
Mailing Address - Phone:865-621-9663
Mailing Address - Fax:
Practice Address - Street 1:103 1ST ST
Practice Address - Street 2:SUITE B
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-2712
Practice Address - Country:US
Practice Address - Phone:865-621-9663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies