Contract Details
Ancillary Care Services
Facility name
Advanced Healthcare
Provider ID
P000004631
NPI
1477660967
Tax ID
621359178
Effective Date
4/1/2012
Last Updated
9/26/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
104 Garner Avenue
Madison, TN 37115
United States
County
Davidson
Phone
6156120087 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address