Contract Details
Ancillary Care Services
Facility name
Express Medical Supply
Provider ID
P000004268
NPI
1316984966
Tax ID
752494404
Effective Date
4/1/2012
Last Updated
11/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
3129 Executive Drive
San Angelo, TX 76904
United States
County
Tom Green
Phone
8779471983 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address