A. Victoria    Smith    OTR
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003837
NPI
1114171113
Tax ID
421659321
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
503 West Ocean Boulevard
Los Fresnos, TX 78566
United States
County
Cameron
Phone
9562334111 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Occupational Therapy
Map
Address