Provider Demographics
NPI:1629181870
Name:YAVAPAI MOBILITY CENTER,LLC
Entity Type:Organization
Organization Name:YAVAPAI MOBILITY CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:LAYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-636-0800
Mailing Address - Street 1:100 N US HIGHWAY 89
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-5980
Mailing Address - Country:US
Mailing Address - Phone:928-636-0800
Mailing Address - Fax:928-636-7921
Practice Address - Street 1:100 N HIGHWAY 89
Practice Address - Street 2:SUITE C
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-5980
Practice Address - Country:US
Practice Address - Phone:928-636-0800
Practice Address - Fax:928-636-7921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
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
5680500001Medicare ID - Type Unspecified