Provider Demographics
NPI:1922364108
Name:LIBERTY SCOOTERS AND POWER CHAIRS SERVICES
Entity type:Organization
Organization Name:LIBERTY SCOOTERS AND POWER CHAIRS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENITO
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:210-521-1264
Mailing Address - Street 1:5503 GRISSOM RD
Mailing Address - Street 2:SUITE 132
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-3036
Mailing Address - Country:US
Mailing Address - Phone:210-521-1264
Mailing Address - Fax:210-521-1542
Practice Address - Street 1:5503 GRISSOM RD
Practice Address - Street 2:SUITE 132
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3036
Practice Address - Country:US
Practice Address - Phone:210-521-1264
Practice Address - Fax:210-521-1542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000359332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6521920001OtherPTAN