Contract Details
Ancillary Care Services
Facility name
Convalescent Supplies
Provider ID
P000006441
Tax ID
621720421
Effective Date
4/1/2012
Last Updated
9/26/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
318 Nancy Lyan Lane Building 2, Suite 11
Knoxville, TN 37919
United States
County
Knox
Phone
8656022455 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address