1811909047 NPI number — SCOOTERS AMERICA LLC

Table of content: (NPI 1811909047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811909047 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:
1811909047
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:
866-822-5201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
454 MOORE LN
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
BILLINGS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59101-4600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-651-0055
Provider Business Practice Location Address Fax Number:
406-656-4752
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: 123224000 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 311600 . This is a "BCBS FEDERAL" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0260208 . This is a "MT WAIVER PROGRAM" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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