Provider Demographics
NPI:1962022475
Name:GREAT AMERICAN SCOOTER COMPANY OF HUMBLE LLC
Entity Type:Organization
Organization Name:GREAT AMERICAN SCOOTER COMPANY OF HUMBLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:LILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-445-0956
Mailing Address - Street 1:2037 JOHNSTON ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2784
Mailing Address - Country:US
Mailing Address - Phone:281-639-4177
Mailing Address - Fax:
Practice Address - Street 1:2037 JOHNSTON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2784
Practice Address - Country:US
Practice Address - Phone:281-639-4177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREAT AMERICAN SCOOTER COMPANY OF HUMBLE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies