Contract Details
Ancillary Care Services
Facility name
Active American Mobility and Medical
Provider ID
P000006495
Tax ID
710890121
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
15229 South West Freeway
Sugar Land, TX 77478
United States
County
Fort Bend
Phone
2812653155 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address