Contract Details
Ancillary Care Services
Facility name
Edge Medical Supply
Provider ID
P000003757
NPI
1073613147
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
411 East Rusk Street
Jacksonville, TX 75766
United States
County
Cherokee
Phone
9035410220 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address