Provider Demographics
NPI:1629148325
Name:ITS OUR INDEPENDENCE MOBILITY CENTER INC
Entity Type:Organization
Organization Name:ITS OUR INDEPENDENCE MOBILITY CENTER INC
Other - Org Name:ADVANCED MOBILITY SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-329-8746
Mailing Address - Street 1:11395 66TH ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-5523
Mailing Address - Country:US
Mailing Address - Phone:727-329-8746
Mailing Address - Fax:727-329-8748
Practice Address - Street 1:11395 66TH ST
Practice Address - Street 2:UNIT B
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-5523
Practice Address - Country:US
Practice Address - Phone:727-329-8746
Practice Address - Fax:727-329-8748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1178570001Medicare NSC