Contract Details
Ancillary Care Services
Facility name
Evidence Medical Technologies
Provider ID
P000004206
NPI
1285928036
Tax ID
273100764
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1008 Winscott Road Suite A
Benbrook, TX 76126
United States
County
Tarrant
Phone
4698148681 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address