Provider Demographics
NPI:1689161572
Name:MEDSOURCE MOBILITY LLC
Entity Type:Organization
Organization Name:MEDSOURCE MOBILITY LLC
Other - Org Name:AAMCO MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-890-6824
Mailing Address - Street 1:10520 S 700 E STE 209
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-0945
Mailing Address - Country:US
Mailing Address - Phone:866-293-3218
Mailing Address - Fax:800-456-6504
Practice Address - Street 1:319 HIGHWAY 30
Practice Address - Street 2:UNIT 3
Practice Address - City:KIMBERLY
Practice Address - State:ID
Practice Address - Zip Code:83341
Practice Address - Country:US
Practice Address - Phone:866-293-3218
Practice Address - Fax:800-456-6504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies