Contract Details
Cardiosom, LLC
Facility name
Cardiosom of Tupelo
Provider ID
P000005796
NPI
1992993992
Tax ID
113733629
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
111 East Troy St Suite C
Tupelo, MS 38804
United States
County
Lee
Phone
6626909780 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address