Contract Details
Ancillary Care Services
Facility name
Healthsource of Mansfield
Provider ID
P000004975
NPI
1629346382
Tax ID
452680655
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
121 West Debbie Lane Suite 115
Mansfield, TX 76063
United States
County
Tarrant
Phone
6825189393 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address