Provider Demographics
NPI:1396766234
Name:SCOOTER STORE - MOBILE LLC
Entity type:Organization
Organization Name:SCOOTER STORE - MOBILE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:CONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-627-4433
Mailing Address - Street 1:P.O. BOX 310709
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78131-0709
Mailing Address - Country:US
Mailing Address - Phone:830-626-4013
Mailing Address - Fax:800-688-0957
Practice Address - Street 1:2810 HORACE SHEPARD DR.
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1007
Practice Address - Country:US
Practice Address - Phone:334-984-0168
Practice Address - Fax:877-230-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1396766234Medicaid
FL002754100Medicaid
GA383886973AMedicaid
4278050002Medicare NSC