Provider Demographics
NPI:1922035567
Name:SOUTHERN MOBILITY AND MEDICAL, LLC
Entity Type:Organization
Organization Name:SOUTHERN MOBILITY AND MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:H
Authorized Official - Last Name:DANNENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-681-8831
Mailing Address - Street 1:503 OBERLIN RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1381
Mailing Address - Country:US
Mailing Address - Phone:800-681-8831
Mailing Address - Fax:877-611-3500
Practice Address - Street 1:503 OBERLIN RD
Practice Address - Street 2:SUITE 207
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1381
Practice Address - Country:US
Practice Address - Phone:800-681-8831
Practice Address - Fax:877-611-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01024332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704279Medicaid
NC7704279Medicaid