Contract Details
Ancillary Care Services
Facility name
180 Medical
Provider ID
P000006172
Tax ID
134211220
Effective Date
4/1/2012
Last Updated
10/16/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
717 Atando Avenue Suite J
Charlotte, NC 28206
United States
County
Mecklenburg
Phone
7042641236 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address