Provider Demographics
NPI:1770891889
Name:UNITED SEATING AND MOBILITY LLC
Entity type:Organization
Organization Name:UNITED SEATING AND MOBILITY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGR LICENSURE AND CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-447-7515
Mailing Address - Street 1:805 BROOK ST STE 402
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3431
Mailing Address - Country:US
Mailing Address - Phone:314-447-7500
Mailing Address - Fax:
Practice Address - Street 1:12285 PELLICANO DR STE D5
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6284
Practice Address - Country:US
Practice Address - Phone:915-591-3130
Practice Address - Fax:915-591-3136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
TX07088917332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2807349-05Medicaid
TX2807349-01Medicaid
TX2807349-03Medicaid
NM33953295Medicaid