Contract Details
Ancillary Care Services
Facility name
Brazoria County CT
Provider ID
P000005635
NPI
1922310556
Tax ID
273005279
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
2760 Brazos Parkway Suite C
Angleton, TX 77515
United States
County
Brazoria
Phone
9798495700 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address