MEDICARE: MOBILITY SCOOTERS OF MADISON 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	332BC3200X	Customized Equipment (DME)	456-1027152998-03	WI

General Provider Information

NPI Number	:	1912207754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILITY SCOOTERS OF MADISON LLC

Provider Business Mailing Address
First Line	:	3411 MILLER ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-2527
Country	:	US
Telephone Number	:	608-228-9090
Fax Number	:	608-241-4628

Provider Business Practice Location Address
First Line	:	3411 MILLER ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-2527
Country	:	US
Telephone Number	:	608-228-9090
Fax Number	:	608-241-4628

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. RONALD JOHN GROSSO
Credential	:
Telephone Number	:	608-228-9090

Provider Enumeration Date	:	10/27/2010
Last Update Date	:	10/27/2010

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