Contract Details
Ancillary Care Services
Facility name
DME Depot
Provider ID
P000004873
NPI
1588656227
Tax ID
200142814
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
5233 IH 37 Suite B-18
Corpus Christi, TX 78408
United States
County
Nueces
Phone
3619925353 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address