Contract Details
Ancillary Care Services
Facility name
Florida Physical Medicine
Provider ID
P000004595
NPI
1457536237
Tax ID
201781179
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
2200 West Bay Drive
Largo, FL 33770
United States
County
Pinellas
Phone
7275182977 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address