Provider Demographics
NPI:1558355123
Name:THE ELECTRIC SCOOTER COMPANY OF OKLAHOMA
Entity Type:Organization
Organization Name:THE ELECTRIC SCOOTER COMPANY OF OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LANNY
Authorized Official - Middle Name:G
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-858-0000
Mailing Address - Street 1:6601 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3401
Mailing Address - Country:US
Mailing Address - Phone:405-858-0000
Mailing Address - Fax:405-858-0001
Practice Address - Street 1:6601 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3401
Practice Address - Country:US
Practice Address - Phone:405-858-0000
Practice Address - Fax:405-858-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100796760AMedicaid
OK100796760AMedicaid