Contract Details
Ancillary Care Services
Facility name
The Scooter Store USA
Provider ID
P000004935
NPI
1609897511
Tax ID
743009939
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
1229 Lakeview Drive Suite A
Franklin, TN 37067
United States
County
Williamson
Phone
8007715449 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address