Contract Details
Ancillary Care Services
Facility name
Axis Medical Supply
Provider ID
P000003792
NPI
1083818744
Tax ID
680637303
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
612 Mission Street
El Paso, TX 79925
United States
County
El Paso
Phone
9152538759 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address