Provider Demographics
NPI:1730140930
Name:MOBILITY CENTER INC
Entity Type:Organization
Organization Name:MOBILITY CENTER INC
Other - Org Name:AMIGO MOBILITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STORE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HURD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-777-2060
Mailing Address - Street 1:6693 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:MI
Mailing Address - Zip Code:48722-9725
Mailing Address - Country:US
Mailing Address - Phone:989-777-2060
Mailing Address - Fax:989-921-5082
Practice Address - Street 1:6693 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:MI
Practice Address - Zip Code:48722-9725
Practice Address - Country:US
Practice Address - Phone:989-777-2060
Practice Address - Fax:989-921-5082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI873015070Medicaid
MI873015070Medicaid