Contract Details
Ancillary Care Services
Facility name
Express Medical Supply
Provider ID
P000005394
NPI
1801830567
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
803 Highway 83 North
Childress, TX 79201
United States
County
Childress
Phone
8007237833 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address