Provider Demographics
NPI:1649274556
Name:MOBILE PROSTHETICS & ORTHOTICS, INC.
Entity type:Organization
Organization Name:MOBILE PROSTHETICS & ORTHOTICS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-245-7770
Mailing Address - Street 1:3160 SOUTHGATE COMMERCE BLVD
Mailing Address - Street 2:STE 38
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-8549
Mailing Address - Country:US
Mailing Address - Phone:407-245-7770
Mailing Address - Fax:407-245-7727
Practice Address - Street 1:3160 SOUTHGATE COMMERCE BLVD
Practice Address - Street 2:STE 38
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-8549
Practice Address - Country:US
Practice Address - Phone:407-245-7770
Practice Address - Fax:407-245-7727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
104514OtherAVMED PROVIDER NUMBER
FL950862700Medicaid
FL950862700Medicaid