Provider Demographics
NPI:1871694216
Name:GREAT AMERICAN SCOOTER COMPANY OF HUMBLE LLC
Entity type:Organization
Organization Name:GREAT AMERICAN SCOOTER COMPANY OF HUMBLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-445-0956
Mailing Address - Street 1:2111 FM 1960 ROAD EAST
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338
Mailing Address - Country:US
Mailing Address - Phone:832-445-0956
Mailing Address - Fax:832-445-0958
Practice Address - Street 1:2111 FM 1960 RD EAST
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5229
Practice Address - Country:US
Practice Address - Phone:832-445-0956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0071765332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156285202Medicaid
TX156285202Medicaid