Contract Details
Ancillary Care Services
Facility name
Freedom Respiratory
Provider ID
P000003854
NPI
1124068614
Tax ID
200028861
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1840 Jefferson Highway Suite 108
Fishersville, VA 22939
United States
County
Augusta
Phone
8663340140 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address