Contract Details
Ancillary Care Services
Facility name
180 Medical
Provider ID
P000004981
NPI
1639160708
Tax ID
134211220
Effective Date
4/1/2012
Last Updated
10/13/2015
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
1909 Montgomery Highway Suite 321
Dothan, AL 36303
United States
County
Houston
Phone
3347922544 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address