Provider Demographics
NPI:1679282966
Name:ADVANCED MOBILITY LLC
Entity type:Organization
Organization Name:ADVANCED MOBILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-456-3557
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-0044
Mailing Address - Country:US
Mailing Address - Phone:715-456-3557
Mailing Address - Fax:
Practice Address - Street 1:449 N WATER ST
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-1016
Practice Address - Country:US
Practice Address - Phone:715-456-3557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies