Donna    Smith    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005161
NPI
1700938669
Tax ID
752318416
Effective Date
4/1/2012
Last Updated
11/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
904 West Moore Avenue
Terrell, TX 75160
United States
County
Kaufman
Phone
9722705555 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address