Provider Demographics
NPI:1568535433
Name:AMERICAN MEDICAL MOBILITY INC
Entity Type:Organization
Organization Name:AMERICAN MEDICAL MOBILITY INC
Other - Org Name:ACS MOBILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:HALLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-224-3547
Mailing Address - Street 1:2493 7TH ST W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-2839
Mailing Address - Country:US
Mailing Address - Phone:651-224-3547
Mailing Address - Fax:
Practice Address - Street 1:2493 7TH ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-2839
Practice Address - Country:US
Practice Address - Phone:651-224-3547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4967470001Medicare NSC