Contract Details
Ancillary Care Services
Facility name
Healthsource of Flower Mound
Provider ID
P000005457
NPI
1831466044
Tax ID
452680764
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
200 Market Place Lane Suite 225
Highland Village, TX 75077
United States
County
Denton
Phone
9729663333 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address