Contract Details
Ancillary Care Services
Facility name
CPS Medical
Provider ID
P000005458
NPI
1841220928
Tax ID
752051360
Effective Date
4/1/2012
Last Updated
11/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
2913 Teague Drive
Tyler, TX 75701
United States
County
Smith
Phone
9035927851 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address