Contract Details
Ancillary Care Services
Facility name
Freedom Respiratory
Provider ID
P000004174
NPI
1275573784
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
630 Abney Road Suite A
Roanoke, VA 24012
United States
County
Roanoke City
Phone
8004900884 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address