Contract Details
Ancillary Care Services
Facility name
Culebra Injury & Pain Clinic
Provider ID
P000003591
NPI
1003002122
Tax ID
260084185
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1430 Culebra Road
San Antonio, TX 78201
United States
County
Bexar
Phone
2107339999 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address