Organization
SOUTHERN ILLINOIS MOBILITY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIP LYERLA ATP (PRESIDENT)
(618) 521-2819
Entity
Organization
Contact information
Practice address
1020 LYERLA LN, ALTO PASS, IL 62905-3015
(618) 521-2819
Mailing address
1020 LYERLA LN, ALTO PASS, IL 62905-3015
(618) 521-2819
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
09/07/2016
Last updated
09/07/2016
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