Provider Demographics
NPI:1619960960
Name:MODERN MEDICAL MOBILITY INC
Entity Type:Organization
Organization Name:MODERN MEDICAL MOBILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC TREAS
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRILL
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MCWILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-232-8112
Mailing Address - Street 1:PO BOX 6102
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-0102
Mailing Address - Country:US
Mailing Address - Phone:816-232-8112
Mailing Address - Fax:816-390-8686
Practice Address - Street 1:2518 MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-1638
Practice Address - Country:US
Practice Address - Phone:816-232-8112
Practice Address - Fax:816-390-8686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1123950001Medicare ID - Type Unspecified