Contract Details
Ancillary Care Services
Facility name
Back To Action
Provider ID
P000004756
NPI
1538176383
Tax ID
364489029
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
5901 McPherson Boulevard Suite 11-B
Laredo, TX 78041
United States
County
Webb
Phone
9567264443 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address