Provider Demographics
NPI:1568603835
Name:INDEPENDENT MOBILITY, LLC
Entity Type:Organization
Organization Name:INDEPENDENT MOBILITY, LLC
Other - Org Name:EASY RIDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SIZEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-655-6112
Mailing Address - Street 1:6465 SAN PABLO AVE
Mailing Address - Street 2:604
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2176
Mailing Address - Country:US
Mailing Address - Phone:415-254-9768
Mailing Address - Fax:
Practice Address - Street 1:6501 SAN PABLO AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-1378
Practice Address - Country:US
Practice Address - Phone:510-428-9933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101200417332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies