Provider Demographics
NPI:1780455014
Name:INFINITE CARE MOBILITY LLC
Entity type:Organization
Organization Name:INFINITE CARE MOBILITY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:OUMA GERALD
Authorized Official - Last Name:GONZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-400-0264
Mailing Address - Street 1:1817 SWEET GUM DR
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-0115
Mailing Address - Country:US
Mailing Address - Phone:682-888-6056
Mailing Address - Fax:
Practice Address - Street 1:1817 SWEET GUM DR
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-0115
Practice Address - Country:US
Practice Address - Phone:682-888-6056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)