Contract Details
Ancillary Care Services
Facility name
The Scooter Store USA
Provider ID
P000003843
NPI
1114949161
Tax ID
571148676
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
8570 Magellan Parkway Suite 500
Richmond, VA 23227
United States
County
Henrico
Phone
8007234535 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address