William    Dodson    RPT
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000006521
Tax ID
752617756
Effective Date
4/1/2012
Last Updated
11/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
405 South Main Avenue Suite 400
Monahans, TX 79756
United States
County
Ward
Phone
4329437876 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Physical Therapy
Map
Address