Provider Demographics
NPI:1952399453
Name:SOUTHEAST MOBILITY GROUP, LLC
Entity Type:Organization
Organization Name:SOUTHEAST MOBILITY GROUP, LLC
Other - Org Name:SCOOTERS UNLIMITED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:DALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-673-6902
Mailing Address - Street 1:615 S YONGE ST
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-7541
Mailing Address - Country:US
Mailing Address - Phone:386-673-6902
Mailing Address - Fax:386-673-6976
Practice Address - Street 1:615 S YONGE ST
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-7541
Practice Address - Country:US
Practice Address - Phone:386-673-6902
Practice Address - Fax:386-673-6976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3122337332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4634510001Medicare NSC