Provider Demographics
NPI:1942631916
Name:SCOOTERS AND MORE FACTORY OUTLET, INC
Entity Type:Organization
Organization Name:SCOOTERS AND MORE FACTORY OUTLET, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRET
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-632-7527
Mailing Address - Street 1:3331 E FIRST ST
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-4523
Mailing Address - Country:US
Mailing Address - Phone:706-632-7527
Mailing Address - Fax:706-632-9804
Practice Address - Street 1:3331 E FIRST ST
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-4523
Practice Address - Country:US
Practice Address - Phone:706-632-7527
Practice Address - Fax:706-632-9804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
3931630001Medicare UPIN