Provider Demographics
NPI:1578586434
Name:SCOOTER STORE - SHREVEPORT LLC
Entity Type:Organization
Organization Name:SCOOTER STORE - SHREVEPORT LLC
Other - Org Name:THE SCOOTER STORE/ALLIANCE SEATING AND MOBILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:CONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-627-4433
Mailing Address - Street 1:PO BOX 310709
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78131-0709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9644 SAINT VINCENT AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7127
Practice Address - Country:US
Practice Address - Phone:318-865-1564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE SCOOTER STORE - USA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-25
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157486502Medicaid
AR149016716Medicaid
TX157486501Medicaid
TX157486504Medicaid
TX157486503Medicaid
LA1120006Medicaid
4286590001Medicare NSC