Provider Demographics
NPI:1922097096
Name:ACTION MOBILITY INC
Entity Type:Organization
Organization Name:ACTION MOBILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:VIVIANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-674-8550
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61650-0115
Mailing Address - Country:US
Mailing Address - Phone:309-674-8550
Mailing Address - Fax:309-674-8505
Practice Address - Street 1:2104 W TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1547
Practice Address - Country:US
Practice Address - Phone:309-674-8550
Practice Address - Fax:309-674-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000438332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL4705660001Medicare NSC