Contract Details
Ancillary Care Services
Facility name
The Scooter Store
Provider ID
P000004878
NPI
1588699193
Tax ID
743009902
Effective Date
4/1/2012
Last Updated
10/16/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
400 Clanton Road Suite G
Charlotte, NC 28217
United States
County
Mecklenburg
Phone
8007715449 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address