Contract Details
Ancillary Care Services
Facility name
The Scooter Store USA
Provider ID
P000004012
NPI
1205918521
Tax ID
010560608
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
P.O. Box 310709
New Braunfels, TX 78131
United States
County
Comal
Phone
8007715449 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address