Dannita    Crossfield    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005811
NPI
1356332118
Tax ID
611208897
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
212 Wayne Drive
Richmond, KY 40475
United States
County
Madison
Phone
8592342600 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address