Provider Demographics
NPI:1720035801
Name:MR. MOBILITY MEDICAL, INC.
Entity Type:Organization
Organization Name:MR. MOBILITY MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:ZMYJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-323-8585
Mailing Address - Street 1:1323 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6600
Mailing Address - Country:US
Mailing Address - Phone:352-323-8585
Mailing Address - Fax:352-323-4802
Practice Address - Street 1:1323 S 14TH ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6600
Practice Address - Country:US
Practice Address - Phone:352-323-8585
Practice Address - Fax:352-323-4802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1057332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR9210OtherBCBS
FL022471500Medicaid
FL022471500Medicaid