Contract Details
Facility name
Hair Specialty Supply Company
Provider ID
P000004366
NPI
1366625790
Tax ID
261446131
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
5707 TPC Pkwy Suite 1630
San Antonio, TX 78261
United States
County
Bexar
Phone
2103673800 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address