Provider Demographics
NPI:1508841651
Name:HANDICAPPED MOBILITY INC
Entity Type:Organization
Organization Name:HANDICAPPED MOBILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-936-7747
Mailing Address - Street 1:PO BOX 320997
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-0997
Mailing Address - Country:US
Mailing Address - Phone:601-936-7747
Mailing Address - Fax:601-936-7252
Practice Address - Street 1:2627 COURTHOUSE CIR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9521
Practice Address - Country:US
Practice Address - Phone:601-936-7747
Practice Address - Fax:601-936-7252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS061117768335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00040083Medicaid
MS00040083Medicaid