Provider Demographics
NPI:1932495652
Name:TRINITY MOBILITY, LLC
Entity Type:Organization
Organization Name:TRINITY MOBILITY, LLC
Other - Org Name:ABIDE DIRECT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUNDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-939-3333
Mailing Address - Street 1:2951 ELKTON TRL STE A
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0675
Mailing Address - Country:US
Mailing Address - Phone:903-865-0073
Mailing Address - Fax:888-453-0568
Practice Address - Street 1:2951 ELKTON TRL STE A
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0675
Practice Address - Country:US
Practice Address - Phone:903-865-0073
Practice Address - Fax:888-453-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX332B00000X
TX1000901332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX289929601Medicaid
TX6622710001Medicare NSC
TX289929601Medicaid