Provider Demographics
NPI:1467459560
Name:MEDICAL MOBILITY OF TEXAS, LLC
Entity Type:Organization
Organization Name:MEDICAL MOBILITY OF TEXAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:214-239-2900
Mailing Address - Street 1:2422 ARBUCKLE COURT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-4506
Mailing Address - Country:US
Mailing Address - Phone:214-239-2900
Mailing Address - Fax:214-239-2905
Practice Address - Street 1:2422 ARBUCKLE COURT
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-4506
Practice Address - Country:US
Practice Address - Phone:214-239-2900
Practice Address - Fax:214-239-2905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0074794332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5109380001Medicare ID - Type UnspecifiedMEDICARE