Provider Demographics
NPI:1669564233
Name:ADVANCED MOBILITY SOLUTIONS
Entity type:Organization
Organization Name:ADVANCED MOBILITY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:F
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-438-2338
Mailing Address - Street 1:4669 CASS UNION ROAD
Mailing Address - Street 2:
Mailing Address - City:RISING SUN
Mailing Address - State:IN
Mailing Address - Zip Code:47040-9690
Mailing Address - Country:US
Mailing Address - Phone:812-438-2338
Mailing Address - Fax:812-438-9523
Practice Address - Street 1:4669 CASS UNION ROAD
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:IN
Practice Address - Zip Code:47040-9690
Practice Address - Country:US
Practice Address - Phone:812-438-2338
Practice Address - Fax:812-438-9523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IN000000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1690507OtherNMEDA
IN5494990001Medicare ID - Type Unspecified
OH2640271Medicaid
IN1669564233OtherNPI
KY50009179OtherPASSPORT HEALTH PLAN
IN69000194AOtherDME HME LICENSE
IN=========000OtherCARE SOURCE
KY90012311Medicaid