Provider Demographics
NPI:1407108046
Name:ROOTS SCOOTER RENTAL, SALES & DISTRIBUTOR
Entity Type:Organization
Organization Name:ROOTS SCOOTER RENTAL, SALES & DISTRIBUTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAGIILIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRUEAN
Authorized Official - Suffix:
Authorized Official - Credentials:PRIVATE BUSINES
Authorized Official - Phone:684-699-0882
Mailing Address - Street 1:6655 NUUULI STREET
Mailing Address - Street 2:
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799
Mailing Address - Country:US
Mailing Address - Phone:684-699-0882
Mailing Address - Fax:
Practice Address - Street 1:6655 NUUULI STREET
Practice Address - Street 2:
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799
Practice Address - Country:US
Practice Address - Phone:684-699-0882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies