Provider Demographics
NPI:1497757843
Name:MTG MOBILITY, L.L.C.
Entity Type:Organization
Organization Name:MTG MOBILITY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RTS, COO
Authorized Official - Prefix:MR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-765-3860
Mailing Address - Street 1:233 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:MI
Mailing Address - Zip Code:49325
Mailing Address - Country:US
Mailing Address - Phone:616-765-3860
Mailing Address - Fax:616-765-3866
Practice Address - Street 1:233 COUNTY LINE ROAD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:MI
Practice Address - Zip Code:49325
Practice Address - Country:US
Practice Address - Phone:616-765-3860
Practice Address - Fax:616-765-3866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4758437Medicaid
MI5381660001Medicare ID - Type Unspecified