Contract Details
Ancillary Care Services
Facility name
Encore Respiratory
Provider ID
P000005164
NPI
1700989241
Tax ID
593641476
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
4755 Drane Field Road Suite 101
Lakeland, FL 33811
United States
County
Polk
Phone
8634013762 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address