Provider Demographics
NPI:1366483810
Name:SCOOTER MART INC
Entity Type:Organization
Organization Name:SCOOTER MART INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SONGER
Authorized Official - Suffix:
Authorized Official - Credentials:LUTCF
Authorized Official - Phone:254-629-2416
Mailing Address - Street 1:208 S LAMAR
Mailing Address - Street 2:
Mailing Address - City:EASTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76448
Mailing Address - Country:US
Mailing Address - Phone:254-629-2416
Mailing Address - Fax:254-629-0998
Practice Address - Street 1:208 S LAMAR
Practice Address - Street 2:
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448
Practice Address - Country:US
Practice Address - Phone:254-629-2416
Practice Address - Fax:254-629-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1272880001Medicare NSC