Provider Demographics
NPI:1760735203
Name:THE SCOOTER STORE - PORTLAND, LLC
Entity Type:Organization
Organization Name:THE SCOOTER STORE - PORTLAND, LLC
Other - Org Name:ALLIANCE SEATING & 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 1:1650 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-3832
Mailing Address - Country:US
Mailing Address - Phone:830-626-5600
Mailing Address - Fax:800-688-0957
Practice Address - Street 1:4779 AIRWAY DR
Practice Address - Street 2:UNIT #100
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97502-3606
Practice Address - Country:US
Practice Address - Phone:503-682-3031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE SCOOTER STORE - USA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-22
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies