Provider Demographics
NPI:1598106007
Name:ROOTS SCOOTER RENTAL, SALES & DISTRIBUTOR OF MEDICAL HOMECARE PRODUCTS
Entity Type:Organization
Organization Name:ROOTS SCOOTER RENTAL, SALES & DISTRIBUTOR OF MEDICAL HOMECARE PRODUCTS
Other - Org Name:ASSISTIVE MOBILITY ASSISTIVE EQUIPMENTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FRUEAN
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:684-770-8666
Mailing Address - Street 1:PO BOX 6655
Mailing Address - Street 2:
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799-6287
Mailing Address - Country:US
Mailing Address - Phone:684-699-0881
Mailing Address - Fax:
Practice Address - Street 1:6655 NUUULI ST,
Practice Address - Street 2:
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799-6287
Practice Address - Country:US
Practice Address - Phone:684-699-0881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies