MEDICARE: MOBILITY SCOOTERS OF WASHINGTON 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	18062083	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	183695	OTHER	MO	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932216421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILITY SCOOTERS OF WASHINGTON LLC

Provider Business Mailing Address
First Line	:	308 JEFFERSON ST
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-2634
Country	:	US
Telephone Number	:	163-623-9996
Fax Number	:	163-623-9953

Provider Business Practice Location Address
First Line	:	308 JEFFERSON ST
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-2634
Country	:	US
Telephone Number	:	163-623-9996
Fax Number	:	163-623-9953

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. NANCY J HARDIN
Credential	:
Telephone Number	:	16362399963

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	08/07/2008

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