Contract Details
Ancillary Care Services
Facility name
Express Medical Supply
Provider ID
P000005708
NPI
1962440180
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
1523 Northwest Boulevard Suite A
Georgetown, TX 78628
United States
County
Williamson
Phone
3039058527 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address