1235141474 NPI number — SCOOTERS AMERICA LLC

Table of content: (NPI 1235141474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235141474 NPI number — SCOOTERS AMERICA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOOTERS AMERICA LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235141474
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5959 SHALLOWFORD RD STE 443
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37421-2245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-756-2268
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 STEWART RD SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PACIFIC
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98047-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-896-3535
Provider Business Practice Location Address Fax Number:
866-822-5201
Provider Enumeration Date:
08/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MATUKEWICZ
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
423-756-2268

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0221978 . This is a "WA L AND I" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9052929 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 181416 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 613316800 . This is a "L&I" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".