Imed Mobility

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

A637163000 Issued in MN

Legal business name

IMED MOBILITY

Practice address

1915 County Road C W
Roseville, MN 55113-1320

Phone

(651) 635-0655

NPI assigned

Jan 11, 2012

Last updated

Jan 11, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kaytey L Gilgenbach

Title

Accounting

Phone

(651) 635-0655

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326240000000",
    "number": "1063782704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1915 COUNTY ROAD C W",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 COUNTY ROAD C W",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131320",
            "telephone_number": "651-635-0655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMED MOBILITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-11",
        "last_updated": "2012-01-11",
        "status": "A",
        "authorized_official_last_name": "GILGENBACH",
        "authorized_official_first_name": "KAYTEY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ACCOUNTING",
        "authorized_official_telephone_number": "651-635-0655"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "MN",
            "license": "A637163000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "A637163000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Customized Equipment (DME) in Roseville, MN
• Providers in Roseville, MN by specialty
• Customized Equipment (DME) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.