Provider Demographics
NPI:1710232715
Name:INDEPENDENCEFIRST MOBILITY STORE
Entity Type:Organization
Organization Name:INDEPENDENCEFIRST MOBILITY STORE
Other - Org Name:WHEELCHAIR RECYCLING PROGRAM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-988-5333
Mailing Address - Street 1:3720 N 124TH ST STE F
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2100
Mailing Address - Country:US
Mailing Address - Phone:414-988-5333
Mailing Address - Fax:414-988-5330
Practice Address - Street 1:12040 W FEERICK ST STE N
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-2109
Practice Address - Country:US
Practice Address - Phone:414-988-5333
Practice Address - Fax:414-988-5330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDEPENDENCEFIRST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-17
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies