Contract Details
Ancillary Care Services
Facility name
The Scooter Store
Provider ID
P000005142
NPI
1700028065
Tax ID
743014718
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
4401 South Pinemont Drive Suite 216
Houston, TX 77041
United States
County
Harris
Phone
8007234535 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address