Adam Jay    Carter    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005749
NPI
1972660660
Tax ID
020784439
Effective Date
4/1/2012
Last Updated
9/27/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2210 8th Avenue South
Nashville, TN 37204
United States
County
Davidson
Phone
6153293779 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address