Contract Details
The Scooter Store USA
Facility name
The Scooter Store USA
Provider ID
P000004860
NPI
1578589347
Tax ID
300121260
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
2749 86th St
Urbandale, IA 50322
United States
County
Polk
Phone
8007715449 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address