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Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005475
NPI
1851463301
Tax ID
742982534
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1360 North Lee Trevino Drive Suite 109
El Paso, TX 79936
United States
County
El Paso
Phone
9156338150 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address