Contract Details
Ancillary Care Services
Facility name
Harbor Alliance
Provider ID
P000005240
NPI
1740364934
Tax ID
205766150
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
13940 Bammel North Houston Road Suite 102
Houston, TX 77066
United States
County
Harris
Phone
2813978741 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address