Provider Demographics
NPI:1619909405
Name:ADVANCED MOBILITY LLC
Entity Type:Organization
Organization Name:ADVANCED MOBILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-240-4055
Mailing Address - Street 1:12745 S SAGINAW ST
Mailing Address - Street 2:STE. 806 PMB. 363
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2437
Mailing Address - Country:US
Mailing Address - Phone:810-240-4055
Mailing Address - Fax:810-953-6560
Practice Address - Street 1:10469 GRANDVIEW
Practice Address - Street 2:
Practice Address - City:GOODRICH
Practice Address - State:MI
Practice Address - Zip Code:48438
Practice Address - Country:US
Practice Address - Phone:810-240-4055
Practice Address - Fax:810-953-6560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI488227887Medicaid
MI488227887Medicaid