Provider Demographics
NPI:1740375807
Name:SOUTHWEST MOBILITY INC
Entity type:Organization
Organization Name:SOUTHWEST MOBILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-654-2292
Mailing Address - Street 1:4406 E MAIN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-7910
Mailing Address - Country:US
Mailing Address - Phone:480-654-2292
Mailing Address - Fax:480-654-2314
Practice Address - Street 1:15458 N 99TH AVE
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-1973
Practice Address - Country:US
Practice Address - Phone:623-875-7296
Practice Address - Fax:623-875-8443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07381180X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0272250OtherBLUE CROSS
AZ111609Medicaid
AZAZ0272250OtherBLUE CROSS