MEDICARE: SCOOTER BROTHERS ENTERPRISES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1548667272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOOTER BROTHERS ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	219 RACETRACK RD NW
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1574
Country	:	US
Telephone Number	:	850-863-8530
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 RACETRACK RD NW
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1574
Country	:	US
Telephone Number	:	850-863-8530
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. NIC A ALLEGRETTO
Credential	:
Telephone Number	:	850-863-8530

Provider Enumeration Date	:	11/24/2014
Last Update Date	:	11/24/2014

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