Provider Demographics
NPI:1174816508
Name:ACTIVE AMERICAN SCOOTER CO.
Entity Type:Organization
Organization Name:ACTIVE AMERICAN SCOOTER CO.
Other - Org Name:ACTIVE AMERICAN MOBILITY & MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-495-4400
Mailing Address - Street 1:103 CIRCLE WAY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5233
Mailing Address - Country:US
Mailing Address - Phone:979-297-3155
Mailing Address - Fax:979-297-2695
Practice Address - Street 1:11034 SHADY TRL
Practice Address - Street 2:112
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-5625
Practice Address - Country:US
Practice Address - Phone:888-734-2207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment