Contract Details
Ancillary Care Services
Facility name
The Scooter Store USA
Provider ID
P000005041
NPI
1669407334
Tax ID
743009887
Effective Date
4/1/2012
Last Updated
6/9/2016
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
3728 1st Avenue North
Birmingham, AL 35222
United States
County
Jefferson
Phone
8007715449 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Billing Phone
8007715449
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address