Contract Details
Ancillary Care Services
Facility name
The Scooter Store
Provider ID
P000005176
NPI
1710904412
Tax ID
743014720
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
4617 50th Street
Lubbock, TX 79407
United States
County
Lubbock
Phone
8007234535 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address