Provider Demographics
NPI:1831481183
Name:AMERICAN MOBILITY REPAIR SERVICE
Entity Type:Organization
Organization Name:AMERICAN MOBILITY REPAIR SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:DELAINE
Authorized Official - Last Name:BLUME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-303-5352
Mailing Address - Street 1:4876 BAUMGARTNER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-2820
Mailing Address - Country:US
Mailing Address - Phone:314-416-4331
Mailing Address - Fax:314-416-4337
Practice Address - Street 1:4876 BAUMGARTNER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-2820
Practice Address - Country:US
Practice Address - Phone:314-416-4331
Practice Address - Fax:314-416-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies