Contract Details
Ancillary Care Services
Facility name
Advanced Audiology & Hearing Aid Center
Provider ID
P000005570
NPI
1891944245
Tax ID
264180821
Effective Date
4/1/2012
Last Updated
9/27/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1676 Mulkey Road Suite 100
Austell, GA 30106
United States
County
Cobb
Phone
7704855403 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address