Provider Demographics
NPI:1912207754
Name:MOBILITY SCOOTERS OF MADISON LLC
Entity Type:Organization
Organization Name:MOBILITY SCOOTERS OF MADISON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GROSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-228-9090
Mailing Address - Street 1:3411 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-2527
Mailing Address - Country:US
Mailing Address - Phone:608-228-9090
Mailing Address - Fax:608-241-4628
Practice Address - Street 1:3411 MILLER ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-2527
Practice Address - Country:US
Practice Address - Phone:608-228-9090
Practice Address - Fax:608-241-4628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI456-1027152998-03332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment