Provider Demographics
NPI:1689788309
Name:ACTIVE AMERICAN SCOOTER CO.
Entity Type:Organization
Organization Name:ACTIVE AMERICAN SCOOTER CO.
Other - Org Name:ACTIVE AMERICAN MOBILITY AND MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:LOWELL
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-709-9521
Mailing Address - Street 1:17312 HIGHWAY 3
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4133
Mailing Address - Country:US
Mailing Address - Phone:281-338-0701
Mailing Address - Fax:281-338-0703
Practice Address - Street 1:17312 HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4133
Practice Address - Country:US
Practice Address - Phone:281-338-0701
Practice Address - Fax:281-338-0703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171395002Medicaid
TX171395001Medicaid
TX171395001Medicaid