Nicholas    Martin    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003592
NPI
1003032053
Tax ID
550719300
Effective Date
4/1/2012
Last Updated
10/21/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
1114 Ridge Avenue
New Cumberland, WV 26047
United States
County
Hancock
Phone
3045641098 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address