Provider Demographics
NPI:1710244363
Name:INDEPENDENT MOBILITY LLC
Entity Type:Organization
Organization Name:INDEPENDENT MOBILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:COWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-653-5031
Mailing Address - Street 1:18994 HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:MO
Mailing Address - Zip Code:63459-4808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18994 HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:MO
Practice Address - Zip Code:63459-4808
Practice Address - Country:US
Practice Address - Phone:217-653-5031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment