Contract Details
Ancillary Care Services
Facility name
Alicks Home Medical Equipment
Provider ID
P000006107
Tax ID
351548294
Effective Date
4/1/2012
Last Updated
10/21/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
952 East Jackson Boulevard
Elkhart, IN 46516
United States
County
Elkhart
Phone
5742736000 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address