Provider Demographics
NPI:1982786117
Name:SHOW ME MOBILITY LLC
Entity Type:Organization
Organization Name:SHOW ME MOBILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-368-1459
Mailing Address - Street 1:1214 HWY 72 E
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401
Mailing Address - Country:US
Mailing Address - Phone:573-364-2524
Mailing Address - Fax:573-426-6383
Practice Address - Street 1:1214 HIGHWAY 72 EAST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401
Practice Address - Country:US
Practice Address - Phone:573-364-2524
Practice Address - Fax:573-426-6383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO626322200Medicaid
MO626322200Medicaid