Contract Details
Edgepark Medical Supplies
Facility name
Edgepark Medical Supplies
Provider ID
P000004931
NPI
1609858729
Tax ID
341650951
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
620 Pierce Rd
Clifton Park, NY 12065
United States
County
Saratoga
Phone
8003075930 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address