Provider Demographics
NPI:1538489257
Name:MOBILITY OVERSTOCK LLC.
Entity Type:Organization
Organization Name:MOBILITY OVERSTOCK LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WIRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-973-4171
Mailing Address - Street 1:3600 N HAYDEN RD
Mailing Address - Street 2:3409
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-4720
Mailing Address - Country:US
Mailing Address - Phone:800-973-4171
Mailing Address - Fax:800-974-3514
Practice Address - Street 1:3600 N HAYDEN RD
Practice Address - Street 2:3409
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-4720
Practice Address - Country:US
Practice Address - Phone:800-973-4171
Practice Address - Fax:800-974-3514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20488888332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies