Provider Demographics
NPI:1972513877
Name:SCOOTER DOCTOR, INC.
Entity Type:Organization
Organization Name:SCOOTER DOCTOR, INC.
Other - Org Name:THE SCOOTER DOCTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-399-1313
Mailing Address - Street 1:3435 PHILLIPS HWY
Mailing Address - Street 2:SUITE A301
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-5615
Mailing Address - Country:US
Mailing Address - Phone:904-399-1313
Mailing Address - Fax:904-399-3392
Practice Address - Street 1:3435 PHILLIPS HWY
Practice Address - Street 2:SUITE A301
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-5615
Practice Address - Country:US
Practice Address - Phone:904-399-1313
Practice Address - Fax:904-399-3392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312807332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5613420001Medicare ID - Type Unspecified