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General NPI Number Information
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NPI Number | 1275550253
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Entity Type | Organization
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Legal Business Name | SCOOTER STORE - JACKSONVILLE LLC
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 08/09/2013
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Provider Practice Location Address
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Address Line | 2431 SAINT JOHNS BLUFF RD S STE 113
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City | JACKSONVILLE
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State | FL
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Zip | 32246-2343
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Country | US
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Telephone | 904-741-5226
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 310709
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City | NEW BRAUNFELS
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State | TX
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Zip | 78131-0709
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | GENERAL COUNSEL & SECRETARY
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Name | JASON CONE
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Credential |
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Telephone | 830-627-4433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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