Provider Demographics
NPI:1184735227
Name:ABLE MOBILITY AND MEDICAL SUPPLY
Entity type:Organization
Organization Name:ABLE MOBILITY AND MEDICAL SUPPLY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:TOMME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-796-0584
Mailing Address - Street 1:PO BOX 92728
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0728
Mailing Address - Country:US
Mailing Address - Phone:817-796-0584
Mailing Address - Fax:817-796-0585
Practice Address - Street 1:190 WEST HIGHWAY 114
Practice Address - Street 2:SUITE F
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-3612
Practice Address - Country:US
Practice Address - Phone:817-796-0584
Practice Address - Fax:817-796-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0085554332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5579780001Medicare ID - Type Unspecified