Organization
ACTIVE AMERICAN SCOOTER COMPANY
Active
Other names
Active American Mobility and Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SOLOMON LOWELL ADAMS (VICE PRESIDENT)
(979) 709-9521
Entity
Organization
Contact information
Practice address
103 CIRCLE WAY ST, LAKE JACKSON, TX 77566-5233
(979) 297-3155
(979) 297-2695
Mailing address
103 CIRCLE WAY ST, LAKE JACKSON, TX 77566-5233
(979) 297-3155
(979) 297-2695
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15407701
—
TX
05
—
1540775-02
—
TX
Enumeration date
08/18/2006
Last updated
05/27/2011
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