Provider Demographics
NPI:1477791788
Name:MOBILITY TRANSPORT, LLC
Entity Type:Organization
Organization Name:MOBILITY TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:
Authorized Official - Last Name:KOONCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-696-6718
Mailing Address - Street 1:566 S LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-1363
Mailing Address - Country:US
Mailing Address - Phone:219-696-6718
Mailing Address - Fax:
Practice Address - Street 1:566 S LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-1363
Practice Address - Country:US
Practice Address - Phone:219-696-6718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347B00000XTransportation ServicesBus
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)