Provider Demographics
NPI:1336434828
Name:THE SCOOTER STORE
Entity type:Organization
Organization Name:THE SCOOTER STORE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REHAB SALES
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:JULIAN
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:ATP
Authorized Official - Phone:214-629-4270
Mailing Address - Street 1:609 ELM ST
Mailing Address - Street 2:
Mailing Address - City:PILOT POINT
Mailing Address - State:TX
Mailing Address - Zip Code:76258-2741
Mailing Address - Country:US
Mailing Address - Phone:214-629-4270
Mailing Address - Fax:866-867-2895
Practice Address - Street 1:1650 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-3832
Practice Address - Country:US
Practice Address - Phone:800-723-4535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE SCOOTER STORE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment