Provider Demographics
NPI:1245352244
Name:INDEPENDENT MOBILITY ENTERPRISES
Entity type:Organization
Organization Name:INDEPENDENT MOBILITY ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:JUSTICE
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-942-3270
Mailing Address - Street 1:129 S BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-8417
Mailing Address - Country:US
Mailing Address - Phone:870-942-3270
Mailing Address - Fax:
Practice Address - Street 1:129 S BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-8417
Practice Address - Country:US
Practice Address - Phone:870-942-3270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR146564716Medicaid
AR49839OtherBLUE CROSS BLUE SHIELD
AR4442730001Medicare ID - Type Unspecified