Contract Details
Ancillary Care Services
Facility name
The Scooter Store Orlando
Provider ID
P000003936
NPI
1164443081
Tax ID
743009943
Effective Date
4/1/2012
Last Updated
10/9/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
1685 Target Court Unit 18
Fort Myers, FL 33905
United States
County
Lee
Phone
8007715449 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address