Contract Details
Ancillary Care Services
Facility name
Air Affiliates
Provider ID
P000004169
NPI
1275548612
Tax ID
621166546
Effective Date
4/1/2012
Last Updated
9/26/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
209 North Main Street
Jellico, TN 37762
United States
County
Campbell
Phone
4237840986 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address