Provider Demographics
NPI:1437188281
Name:THE MOBILITY STORE INC.
Entity Type:Organization
Organization Name:THE MOBILITY STORE INC.
Other - Org Name:THE MOBILITY STORE INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-814-5438
Mailing Address - Street 1:5544 KOSTORYZ RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-2418
Mailing Address - Country:US
Mailing Address - Phone:361-814-5438
Mailing Address - Fax:512-857-6235
Practice Address - Street 1:5544 KOSTORYZ RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-2418
Practice Address - Country:US
Practice Address - Phone:361-814-5438
Practice Address - Fax:361-857-6235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194569301Medicaid
TX194569302Medicaid
TX0953550002Medicare NSC