Provider Demographics
NPI:1144355199
Name:FREEDOM MOBILITY LLC
Entity type:Organization
Organization Name:FREEDOM MOBILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCANLESS
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:317-209-8004
Mailing Address - Street 1:222 SHELTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123
Mailing Address - Country:US
Mailing Address - Phone:317-209-8004
Mailing Address - Fax:317-272-1966
Practice Address - Street 1:222 SHELTON DRIVE
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123
Practice Address - Country:US
Practice Address - Phone:317-209-8004
Practice Address - Fax:317-272-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN69000088A332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
5600870001Medicare NSC