Contract Details
Ancillary Care Services
Facility name
The Scooter Store USA
Provider ID
P000005610
NPI
1912924986
Tax ID
743009914
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
125 Paul Truitt Lane
Pearl, MS 39208
United States
County
Rankin
Phone
8007715449 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address