Provider Demographics
NPI:1669546370
Name:MOBILE MEDICAL MAINTENANCE, LLC
Entity type:Organization
Organization Name:MOBILE MEDICAL MAINTENANCE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CAMEO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEHNDER
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:651-604-5165
Mailing Address - Street 1:383 W. WASHINGTON CTR. ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825
Mailing Address - Country:US
Mailing Address - Phone:260-627-5108
Mailing Address - Fax:517-659-5906
Practice Address - Street 1:383 W WASHINGTON CENTER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825
Practice Address - Country:US
Practice Address - Phone:260-627-5108
Practice Address - Fax:517-659-5906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540C811820OtherBLUE CROSS BLUE SHIELS
5479780002Medicare NSC