Contract Details
Ancillary Care Services
Facility name
The Scooter Store USA
Provider ID
P000004428
NPI
1396762167
Tax ID
743009921
Effective Date
4/1/2012
Last Updated
9/27/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
8705 Unicorn Drive Suite A102
Knoxville, TN 37923
United States
County
Knox
Phone
8007715449 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address