MEDICARE: SCOOTER STORE - LOS ANGELES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174549513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOOTER STORE - LOS ANGELES LLC

Provider Business Mailing Address
First Line	:	PO BOX 310709
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78131-0709
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 N SUNSET AVE
Second Line	:
City	:	CITY OF INDUSTRY
State	:	CA
Zip	:	91744-3524
Country	:	US
Telephone Number	:	626-369-8458
Fax Number	:

Authorized Official
Title or Position	:	GENERAL COUNSEL & SECRETARY
Name	:	JASON CONE
Credential	:
Telephone Number	:	830-627-4433

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	08/09/2013

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Directions to “SCOOTER STORE - LOS ANGELES LLC ” Practice Location

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