Contract Details
Facility name
Direct Medical Inc
Provider ID
P000004084
NPI
1235314659
Tax ID
760350861
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
404e Fannin Ave
Crockett, TX 75835
United States
County
Houston
Phone
9365443361 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address