Contract Details
Ancillary Care Services
Facility name
Edge Medical Supply
Provider ID
P000003615
NPI
1013005545
Tax ID
680498916
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
1331 South Beckham Avenue
Tyler, TX 75701
United States
County
Smith
Phone
9035937848 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address