Provider Demographics
NPI:1821042136
Name:INDEPENDENT MOBILITY PLUS, INC.
Entity Type:Organization
Organization Name:INDEPENDENT MOBILITY PLUS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-965-6000
Mailing Address - Street 1:450 N MILITARY AVE
Mailing Address - Street 2:SUITE #7
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-4570
Mailing Address - Country:US
Mailing Address - Phone:920-965-6000
Mailing Address - Fax:920-491-0527
Practice Address - Street 1:450 N MILITARY AVE
Practice Address - Street 2:SUITE #7
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-4570
Practice Address - Country:US
Practice Address - Phone:920-965-6000
Practice Address - Fax:920-491-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41750600Medicaid
WI5485830001Medicare NSC