Contract Details
Ancillary Care Services
Facility name
Alta Physician's Management
Provider ID
P000005169
NPI
1710084926
Tax ID
141849054
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
322 South Flores Street
San Antonio, TX 78204
United States
County
Bexar
Phone
2102220999 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address