Organization
ADVANCED MOBILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. COLTER DAR KIRKHAM (OWNER)
(208) 478-6554
Entity
Organization
Contact information
Practice address
450 E DAY ST, SUITE F, POCATELLO, ID 83201-7204
(208) 478-6554
(208) 478-6551
Mailing address
450 E DAY ST, SUITE F, POCATELLO, ID 83201-7204
(208) 478-6554
(208) 478-6551
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806280600
—
ID
Enumeration date
08/11/2006
Last updated
06/16/2008
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