Contract Details
Ancillary Care Services
Facility name
Four Leaf Clover
Provider ID
P000005262
NPI
1750451357
Tax ID
650595427
Effective Date
5/24/2012
Last Updated
10/16/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
3280 Highway 69 Suite 11
Hayesville, NC 28904
United States
County
Clay
Phone
8282025885 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address