MEDICARE: LONE STAR SCOOTERS, L.L.C.

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	0072472	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	531777	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	452210	OTHER		JACHO
4	V16951	OTHER	TX	VGM

General Provider Information

NPI Number	:	1609958982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONE STAR SCOOTERS, L.L.C.

Provider Business Mailing Address
First Line	:	6225 OAKMONT BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-2812
Country	:	US
Telephone Number	:	817-346-0000
Fax Number	:	817-346-1150

Provider Business Practice Location Address
First Line	:	6225 OAKMONT BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-2812
Country	:	US
Telephone Number	:	817-346-0000
Fax Number	:	817-346-1150

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BRADLEY MICHAEL SMITH
Credential	:
Telephone Number	:	817-346-0000

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	01/25/2008

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