Provider Demographics
NPI:1235141474
Name:SCOOTERS AMERICA LLC
Entity Type:Organization
Organization Name:SCOOTERS AMERICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATUKEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-756-2268
Mailing Address - Street 1:5959 SHALLOWFORD RD STE 443
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2245
Mailing Address - Country:US
Mailing Address - Phone:423-756-2268
Mailing Address - Fax:
Practice Address - Street 1:170 STEWART RD SW
Practice Address - Street 2:
Practice Address - City:PACIFIC
Practice Address - State:WA
Practice Address - Zip Code:98047-2108
Practice Address - Country:US
Practice Address - Phone:253-896-3535
Practice Address - Fax:866-822-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0221978OtherWA L AND I
WA9052929Medicaid
OR181416Medicaid
OR613316800OtherL&I
OR613316800OtherL&I