Provider Demographics
NPI:1689675217
Name:MOBILITY EXPRESS OF SCRANTON, INC.
Entity Type:Organization
Organization Name:MOBILITY EXPRESS OF SCRANTON, INC.
Other - Org Name:MOBILITY EXPRESS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:DIBILEO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:570-344-6555
Mailing Address - Street 1:405 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-2266
Mailing Address - Country:US
Mailing Address - Phone:570-344-6555
Mailing Address - Fax:570-344-2699
Practice Address - Street 1:405 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-2266
Practice Address - Country:US
Practice Address - Phone:570-344-6555
Practice Address - Fax:570-344-2699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA040041800OtherBLACK LUNG PROVIDER
PA601 362 100OtherPA DEPT OF LABOR PROVIDER
PA0078245180002Medicaid
5564300001Medicare NSC