Provider Demographics
NPI:1982763207
Name:JVA MOBILITY INC
Entity Type:Organization
Organization Name:JVA MOBILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLRAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-226-3363
Mailing Address - Street 1:2700 FALLS AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-5724
Mailing Address - Country:US
Mailing Address - Phone:319-226-3363
Mailing Address - Fax:319-226-3584
Practice Address - Street 1:2700 FALLS AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-5724
Practice Address - Country:US
Practice Address - Phone:319-226-3363
Practice Address - Fax:319-226-3584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1-07-036351332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA35294OtherWELLMARK BLUE CROSS
IA0419861Medicaid
IA0419861Medicaid