Provider Demographics
NPI:1710363486
Name:MOTILITY MLK, LLC
Entity Type:Organization
Organization Name:MOTILITY MLK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PROTHETIST
Authorized Official - Phone:417-343-6162
Mailing Address - Street 1:PO BOX 1966
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71902-1966
Mailing Address - Country:US
Mailing Address - Phone:501-620-4800
Mailing Address - Fax:848-272-8975
Practice Address - Street 1:120 HILL ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-6238
Practice Address - Country:US
Practice Address - Phone:501-620-4800
Practice Address - Fax:848-272-8975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARCP2198335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201241430AMedicaid
AR213521716Medicaid
TNQ036977Medicaid
MO1710363486Medicaid
CP2198OtherCERTIFICATION NUMBER CP2198