Provider Demographics
NPI:1023142338
Name:ADVANCED MOBILITY, LLC
Entity type:Organization
Organization Name:ADVANCED MOBILITY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRINCIPLE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYERLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-967-1249
Mailing Address - Street 1:130 LICK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-3270
Mailing Address - Country:US
Mailing Address - Phone:618-658-8580
Mailing Address - Fax:618-658-8680
Practice Address - Street 1:130 LICK CREEK RD
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-3270
Practice Address - Country:US
Practice Address - Phone:618-658-8580
Practice Address - Fax:618-658-8680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1023142338OtherNPI
IL=========OtherEIN