Provider Demographics
NPI:1700992377
Name:ADVANCED MOBILITY B&G INC.
Entity Type:Organization
Organization Name:ADVANCED MOBILITY B&G INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GOLDIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:REYNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-722-0877
Mailing Address - Street 1:1543 YOSEMITE PKWY
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-5207
Mailing Address - Country:US
Mailing Address - Phone:209-722-0877
Mailing Address - Fax:209-726-1382
Practice Address - Street 1:1543 YOSEMITE PKWY
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-5207
Practice Address - Country:US
Practice Address - Phone:209-722-0877
Practice Address - Fax:209-726-1382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA06 00048685332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6244940001Medicare NSC