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General NPI Number Information
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NPI Number | 1578586434
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Entity Type | Organization
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Legal Business Name | SCOOTER STORE - SHREVEPORT LLC
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 08/09/2013
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Provider Practice Location Address
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Address Line | 9644 SAINT VINCENT AVE
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City | SHREVEPORT
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State | LA
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Zip | 71106-7127
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Country | US
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Telephone | 318-865-1564
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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 | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State | TX
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Taxonomy #2
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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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