Provider Demographics
NPI:1669133443
Name:SOUTHERN MOBILITY SPECIALISTS INC
Entity type:Organization
Organization Name:SOUTHERN MOBILITY SPECIALISTS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:PT, C/NDT, ATP
Authorized Official - Phone:662-260-4870
Mailing Address - Street 1:205 COUNTY ROAD 441
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MS
Mailing Address - Zip Code:38851-7642
Mailing Address - Country:US
Mailing Address - Phone:662-448-1179
Mailing Address - Fax:662-448-1189
Practice Address - Street 1:444 E PRESIDENT AVE
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-5500
Practice Address - Country:US
Practice Address - Phone:662-260-4870
Practice Address - Fax:662-260-4764
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN MOBILITY SPECIALISTS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-04
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment