1659382463 NPI number — SCOOTERS AMERICA LLC

Table of content: (NPI 1659382463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659382463 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:
6
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:
1659382463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1640 E SCHNEIDMILLER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POST FALLS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83854-7065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-773-8448
Provider Business Mailing Address Fax Number:
866-821-5201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1640 E SCHNEIDMILLER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POST FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83854-7065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-773-8448
Provider Business Practice Location Address Fax Number:
208-416-2713
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MATUKEWICZ
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
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: 000010139074 . This is a "REGENCE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 181416 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8P038 . This is a "BC OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 100500518 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1659382463 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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