Contract Details
The Scooter Store USA
Facility name
The Scooter Store
Provider ID
P000004859
NPI
1578580262
Tax ID
743009926
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
1174 Route 109
Lindenhurst, NY 11757
United States
County
Suffolk
Phone
8007234535 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address