Contract Details
Ancillary Care Services
Facility name
The Scooter Store USA
Provider ID
P000004243
NPI
1306863345
Tax ID
571148684
Effective Date
4/1/2012
Last Updated
10/21/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
7209 East 87th Street
Indianapolis, IN 46256
United States
County
Marion
Phone
8007715449 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address