Timothy    Sargent    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003648
NPI
1023191897
Tax ID
611357245
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2003 Old Main Street
Washington, KY 41096
United States
County
Mason
Phone
6067599800 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address