Healthcare Provider Details

I. General information

NPI: 1962441980
Provider Name (Legal Business Name): MOBILITY SCOOTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10955 A EASTEX FREEWAY
BEAUMONT TX
77708
US

IV. Provider business mailing address

PO BOX 12686
BEAUMONT TX
77726-2686
US

V. Phone/Fax

Practice location:
  • Phone: 409-347-0173
  • Fax: 409-347-0534
Mailing address:
  • Phone: 409-730-2006
  • Fax: 409-835-7598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0073320
License Number StateTX

VIII. Authorized Official

Name: DEANA O WILSON
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 409-730-2006