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General NPI Number Information
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NPI Number | 1568464584
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Entity Type | Organization
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Legal Business Name | SCOOTER MART INC
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 208 S LAMAR ST
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City | EASTLAND
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State | TX
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Zip | 76448-2712
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Country | US
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Telephone | 254-629-2416
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Fax | 254-629-0998
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Provider Business Mailing Address
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Address Line | 208 S LAMAR ST
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City | EASTLAND
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State | TX
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Zip | 76448-2712
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Country | US
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Telephone | 254-629-2416
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Fax | 254-629-0998
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Authorized Official
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Title or Position | VP
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Name | MR. KENNETH W SONGER
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Credential | LUTCF
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Telephone | 254-629-2416
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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 | 0041085
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License Number State | TX
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