Contract Details
Ancillary Care Services
Facility name
Dale Vincent, PA
Provider ID
P000005741
NPI
1972564250
Tax ID
742753654
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
1103 Sara Swamy Drive
Sherman, TX 75090
United States
County
Grayson
Phone
9038701767 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address