Contract Details
Ancillary Care Services
Facility name
Carolina Diabetic Supply Group
Provider ID
P000004954
NPI
1619956901
Tax ID
562164778
Effective Date
4/1/2012
Last Updated
10/16/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
3336 Martin Luther King, Jr. Boulevard
New Bern, NC 28562
United States
County
Craven
Phone
2526332244 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address