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Contract Details
Ancillary Care Services
Facility name
Cardiosom of Muncie
Provider ID
P000004447
NPI
1396963153
Tax ID
113733629
Effective Date
4/1/2012
Last Updated
10/21/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1200 South Tillotson Overpass Suite 3
Muncie, IN 47304
United States
County
Delaware
Phone
7652827119
(
Phone
)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address