Organization
SCOOTER MALL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL RANDALL SCIVALLY (OWNER)
(256) 489-4503
Entity
Organization
Contact information
Practice address
2316 MEMORIAL PKWY NW, HUNTSVILLE, AL 35810-4506
(256) 489-4503
(256) 489-4506
Mailing address
2316 MEMORIAL PKWY NW, HUNTSVILLE, AL 35810-4506
(256) 489-4503
(256) 489-4506
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
090187
AL
Other
Enumeration date
04/16/2007
Last updated
08/22/2020
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