Contract Details
DME Tennessee, LLC
Facility name
DME of Clarksville
Provider ID
P000003518
NPI
1689968117
Tax ID
271770454
Effective Date
6/20/2012
Last Updated
4/26/2013
Direct Contract
Yes
Term Date
3/12/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
1817 Madison Street Suite 5
Clarksville, TN 37040
United States
County
Montgomery
Phone
9315031309 (Phone)
Billing Details
Address
PO Box 1017
Dickson, TN 370561017
Billing Phone
8886921080
Specialty Type
Durable Medical, Oxygen Equipment & Supplies
Map
Address