Contract Details
Ancillary Care Services
Facility name
Guadalupe Rehab & Pain Center
Provider ID
P000004131
NPI
1255460788
Tax ID
743083336
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2600 West Irving Boulevard
Irving, TX 75061
United States
County
Dallas
Phone
9723138484 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address