Contract Details
DME Tennessee, LLC
Facility name
DME of Jackson
Provider ID
P000003513
NPI
1215221742
Tax ID
271770454
Effective Date
6/20/2012
Last Updated
3/4/2022
Direct Contract
Yes
Term Date
2/28/2022
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
80 Innsdale Court Suite K
Jackson, TN 38301
United States
County
Madison
Phone
8886921080 (Phone)
Billing Details
Address
80 Innsdale Court
Suite K
Dickson, TN 38301
Billing Phone
8886921080
Specialty Type
Durable Medical, Oxygen Equipment & Supplies
Map
Address