Provider Demographics
NPI:1801900527
Name:ACTIVE AMERICAN SCOOTER CO.
Entity type:Organization
Organization Name:ACTIVE AMERICAN SCOOTER CO.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:LOWELL
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-709-9521
Mailing Address - Street 1:13003 MURPHY RD
Mailing Address - Street 2:SUITE G1
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3956
Mailing Address - Country:US
Mailing Address - Phone:281-495-4400
Mailing Address - Fax:281-495-4401
Practice Address - Street 1:13003 MURPHY RD
Practice Address - Street 2:SUITE G1
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3956
Practice Address - Country:US
Practice Address - Phone:281-495-4400
Practice Address - Fax:281-495-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189000601Medicaid
TX189000602Medicaid
TX4534200003Medicare NSC