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General NPI Number Information
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NPI Number | 1871694216
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Entity Type | Organization
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Legal Business Name | GREAT AMERICAN SCOOTER COMPANY OF HUMBLE LLC
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 2111 FM 1960 RD EAST
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City | HUMBLE
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State | TX
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Zip | 77338-5229
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Country | US
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Telephone | 832-445-0956
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Fax |
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Provider Business Mailing Address
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Address Line | 2111 FM 1960 ROAD EAST
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City | HUMBLE
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State | TX
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Zip | 77338
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Country | US
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Telephone | 832-445-0956
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Fax | 832-445-0958
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. TROY R LILES
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Credential |
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Telephone | 832-445-0956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 0071765
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License Number State | TX
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