Provider Demographics
NPI:1790917573
Name:MOBILITY MATTERS AND MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:MOBILITY MATTERS AND MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TABATHA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:OBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-464-9975
Mailing Address - Street 1:115 LAKE ST N
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2504
Mailing Address - Country:US
Mailing Address - Phone:651-464-9975
Mailing Address - Fax:651-464-6425
Practice Address - Street 1:115 LAKE ST N
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2504
Practice Address - Country:US
Practice Address - Phone:651-464-9975
Practice Address - Fax:651-464-6425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6326940001Medicare NSC