Provider Demographics
NPI:1881803617
Name:SPECIAL MOBILITY SERVICES
Entity type:Organization
Organization Name:SPECIAL MOBILITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:STOFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-232-1440
Mailing Address - Street 1:2101 NE FLANDERS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2811
Mailing Address - Country:US
Mailing Address - Phone:503-232-1440
Mailing Address - Fax:
Practice Address - Street 1:3102 E TRENT AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-3800
Practice Address - Country:US
Practice Address - Phone:509-532-9505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9052325Medicaid