Provider Demographics
NPI:1710169370
Name:JOHN W. FRANTOM
Entity Type:Organization
Organization Name:JOHN W. FRANTOM
Other - Org Name:SCOOTERS N MORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:FRANTOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-462-3081
Mailing Address - Street 1:1454 MORTHLAND DR
Mailing Address - Street 2:STE 2
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-6246
Mailing Address - Country:US
Mailing Address - Phone:219-462-3081
Mailing Address - Fax:
Practice Address - Street 1:1454 MORTHLAND DR
Practice Address - Street 2:STE 2
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-6246
Practice Address - Country:US
Practice Address - Phone:219-462-3081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0002078651332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200175850AMedicaid
IN1218260001Medicare NSC