Provider Demographics
NPI:1710408836
Name:FREEDOM MOBILITY CENTER, INC.
Entity Type:Organization
Organization Name:FREEDOM MOBILITY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GILBERT
Authorized Official - Last Name:COTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-658-0817
Mailing Address - Street 1:110 TALBERT POINTE DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-4377
Mailing Address - Country:US
Mailing Address - Phone:704-658-0817
Mailing Address - Fax:
Practice Address - Street 1:224 ONEIL CT STE 23
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7649
Practice Address - Country:US
Practice Address - Phone:803-807-2999
Practice Address - Fax:803-708-1843
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREEDOM MOBILITY CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-28
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703634Medicaid
NC046J3OtherBCBS