Provider Demographics
NPI:1811909047
Name:SCOOTERS AMERICA LLC
Entity type:Organization
Organization Name:SCOOTERS AMERICA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATUKEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-756-2268
Mailing Address - Street 1:1640 E SCHNEIDMILLER AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7065
Mailing Address - Country:US
Mailing Address - Phone:208-773-8448
Mailing Address - Fax:866-822-5201
Practice Address - Street 1:454 MOORE LN
Practice Address - Street 2:STE 3
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-4600
Practice Address - Country:US
Practice Address - Phone:406-651-0055
Practice Address - Fax:406-656-4752
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCOOTERS AMERICA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-13
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY123224000Medicaid
MT311600OtherBCBS FEDERAL
MT0260208OtherMT WAIVER PROGRAM
WY123224000Medicaid