Provider Demographics
NPI:1962441980
Name:MOBILITY SCOOTERS
Entity Type:Organization
Organization Name:MOBILITY SCOOTERS
Other - Org Name:ALLIANCE MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:O
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-730-2006
Mailing Address - Street 1:PO BOX 12686
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-2686
Mailing Address - Country:US
Mailing Address - Phone:409-730-2006
Mailing Address - Fax:409-835-7598
Practice Address - Street 1:10955 A EASTEX FREEWAY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708
Practice Address - Country:US
Practice Address - Phone:409-347-0173
Practice Address - Fax:409-347-0534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0073320332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148223401Medicaid
TX148225901Medicaid
TX148225901Medicaid