Provider Demographics
NPI:1053474817
Name:LAKESIDE MOBILITY & SCOOTER LLC
Entity Type:Organization
Organization Name:LAKESIDE MOBILITY & SCOOTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-332-9555
Mailing Address - Street 1:129 MILTON RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03868-8770
Mailing Address - Country:US
Mailing Address - Phone:603-332-9555
Mailing Address - Fax:
Practice Address - Street 1:129 MILTON RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03868-8770
Practice Address - Country:US
Practice Address - Phone:603-332-9555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30597257Medicaid
NH30763043Medicaid
NH30597257Medicaid