Provider Demographics
NPI:1215077912
Name:MOBILITY CONCEPTS, INC
Entity type:Organization
Organization Name:MOBILITY CONCEPTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT,CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-896-0970
Mailing Address - Street 1:1017 54TH AVE E
Mailing Address - Street 2:SUITE A
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-2730
Mailing Address - Country:US
Mailing Address - Phone:253-896-0970
Mailing Address - Fax:253-896-0971
Practice Address - Street 1:1017 54TH AVE E
Practice Address - Street 2:SUITE A
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-2730
Practice Address - Country:US
Practice Address - Phone:253-896-0970
Practice Address - Fax:253-896-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9042136Medicaid
MT0561731Medicaid
WA733159OtherCOPES PROVIDER NUMBER
WA115206OtherL & I PROVIDER NUMBER
AKMS911WAMedicaid
WA1112190001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER