Contract Details
Ancillary Care Services
Facility name
Express Medical Supply
Provider ID
P000005121
NPI
1699712984
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
603 FM 2093 Suite 1201
Fredericksburg, TX 78624
United States
County
Gillespie
Phone
8778965551 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address