Provider Demographics
NPI:1225298219
Name:SCOOTER DIRECT, LLC.
Entity Type:Organization
Organization Name:SCOOTER DIRECT, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-932-4334
Mailing Address - Street 1:10503 LACERA DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4009
Mailing Address - Country:US
Mailing Address - Phone:813-932-4334
Mailing Address - Fax:
Practice Address - Street 1:11431 CHALLENGER AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-3446
Practice Address - Country:US
Practice Address - Phone:727-816-9772
Practice Address - Fax:727-816-9773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies