Contract Details
Ancillary Care Services
Facility name
Greater Southwest Injury & Rehab
Provider ID
P000005369
NPI
1790899565
Tax ID
161758327
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2304 Bardin Road Suite 201
Grand Prairie, TX 75052
United States
County
Dallas
Phone
9725221511 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address