Provider Demographics
NPI:1801030663
Name:APPLE INDEPENDENCE MOBILITY LLC
Entity Type:Organization
Organization Name:APPLE INDEPENDENCE MOBILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:APPLE
Authorized Official - Suffix:
Authorized Official - Credentials:ATP
Authorized Official - Phone:931-528-5788
Mailing Address - Street 1:306 N WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-5549
Mailing Address - Country:US
Mailing Address - Phone:931-528-5788
Mailing Address - Fax:931-528-5789
Practice Address - Street 1:1152 PINE ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3769
Practice Address - Country:US
Practice Address - Phone:931-528-5788
Practice Address - Fax:931-528-5789
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPLE INDEPENDENCE MOBILITY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-23
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN489332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1455151Medicaid
TN4143488OtherBLUE CROSS BLUE SHIELD
TN01056184OtherAMERIGROUP
TN01056184OtherAMERIGROUP