Provider Demographics
NPI:1265570931
Name:SND SCOOTERS LLC
Entity type:Organization
Organization Name:SND SCOOTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BOSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-648-1762
Mailing Address - Street 1:1451 S LA CANADA DR STE 6
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-1625
Mailing Address - Country:US
Mailing Address - Phone:520-648-1762
Mailing Address - Fax:
Practice Address - Street 1:1451 S LA CANADA DR STE 6
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-1625
Practice Address - Country:US
Practice Address - Phone:520-648-1762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5424170001Medicare ID - Type UnspecifiedPROVIDER #