Provider Demographics
NPI:1780680108
Name:MOBILITY SUPPORT SYSTEMS INC
Entity type:Organization
Organization Name:MOBILITY SUPPORT SYSTEMS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:B
Authorized Official - Last Name:KOEPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-997-3000
Mailing Address - Street 1:560 PINE ISLAND RD
Mailing Address - Street 2:STE 2
Mailing Address - City:N FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-3701
Mailing Address - Country:US
Mailing Address - Phone:239-997-3000
Mailing Address - Fax:239-997-1276
Practice Address - Street 1:560 PINE ISLAND RD
Practice Address - Street 2:STE 2
Practice Address - City:N FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903
Practice Address - Country:US
Practice Address - Phone:239-997-3000
Practice Address - Fax:239-997-1276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1441332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4463370001Medicare NSC