Contract Details
Ancillary Care Services
Facility name
Family Audiology
Provider ID
P000004349
NPI
1366415101
Tax ID
202839297
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
4105 West Spring Creek Parkway Suite 702
Plano, TX 75024
United States
County
Collin
Phone
9729430466 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address