Contract Details
Ancillary Care Services
Facility name
Alliance Medical Supply
Provider ID
P000004244
NPI
1306865340
Tax ID
752568876
Effective Date
4/1/2012
Last Updated
11/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
2333 East 8th Street
Odessa, TX 79761
United States
County
Ector
Phone
4325800171 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address