Contract Details
Facility name
Gaddy Medical Equipment & Supplies
Provider ID
P000004901
NPI
1598763435
Tax ID
752909903
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
300 Hurst St
Center, TX 75935
United States
County
Shelby
Phone
9365904464 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address