Provider Demographics
NPI:1144077090
Name:YOUR MOBILE COSMO
Entity type:Organization
Organization Name:YOUR MOBILE COSMO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEEMER
Authorized Official - Suffix:
Authorized Official - Credentials:CPS
Authorized Official - Phone:866-897-4301
Mailing Address - Street 1:940 COMPASS WEST DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-3440
Mailing Address - Country:US
Mailing Address - Phone:330-787-7911
Mailing Address - Fax:
Practice Address - Street 1:7401 MARKET ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-5621
Practice Address - Country:US
Practice Address - Phone:866-897-4301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies