Provider Demographics
NPI:1720026198
Name:AMIGO MOBILITY CENTER INC.
Entity Type:Organization
Organization Name:AMIGO MOBILITY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHENNA
Authorized Official - Middle Name:N
Authorized Official - Last Name:STRANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-647-8567
Mailing Address - Street 1:2100 N. HIGHWAY 360
Mailing Address - Street 2:STE. 1802
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050
Mailing Address - Country:US
Mailing Address - Phone:972-647-8567
Mailing Address - Fax:972-660-4548
Practice Address - Street 1:2100 N. HIGHWAY 360
Practice Address - Street 2:STE. 1802
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050
Practice Address - Country:US
Practice Address - Phone:972-647-8567
Practice Address - Fax:972-660-4548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0038278332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX015841201Medicaid
TX0158412-01Medicaid
TX0158412-01Medicaid