Contract Details
Ancillary Care Services
Facility name
Anderson Podiatry
Provider ID
P000004194
NPI
1285644302
Tax ID
300687154
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
1407 South Fleishel Avenue Suite 301
Tyler, TX 75701
United States
County
Smith
Phone
9035936104 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Podiatry
Map
Address