Organization
PRESIDENTIAL MOBILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN GRIDER ATP (DME MANAGER)
(479) 332-4990
Entity
Organization
Contact information
Practice address
1010 ROLLING HILLS DR., STE. 110, FAYETTEVILLE, AR 72703
(479) 332-4990
(479) 332-4290
Mailing address
PO BOX 10665, FAYETTEVILLE, AR 72703-0046
(479) 332-4990
(479) 332-4290
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
171WH0202X
Home Modifications Contractor
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130311772
—
AR
05
—
137085716
—
AR
05
—
141768784
—
AR
01
—
48128
BLUE CROSS BLUE SHIELD
AR
Enumeration date
10/11/2005
Last updated
12/18/2024
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