Provider Demographics
NPI:1669440392
Name:SOPERS MOBILITY AIDS LLC
Entity Type:Organization
Organization Name:SOPERS MOBILITY AIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GENEVA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-772-6474
Mailing Address - Street 1:PO BOX 2344
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835
Mailing Address - Country:US
Mailing Address - Phone:208-772-6474
Mailing Address - Fax:208-772-6797
Practice Address - Street 1:7392 N GOVERNMENT WAY
Practice Address - Street 2:
Practice Address - City:DALTON GARDENS
Practice Address - State:ID
Practice Address - Zip Code:83815-8762
Practice Address - Country:US
Practice Address - Phone:208-772-6474
Practice Address - Fax:208-772-6797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID59332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9054511Medicaid
ID805521400Medicaid
ID000010137053OtherREGENCE BLUE SHIELD
ID805503900Medicaid
ID8F728OtherBLUE CROSS OF IDAHO
ID805503900Medicaid