Elmer    Lim    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003873
NPI
1124312624
Tax ID
752198670
Effective Date
4/1/2012
Last Updated
11/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
6500 Quaker Avenue Suite A
Lubbock, TX 79413
United States
County
Lubbock
Phone
8067857771 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address