Contract Details
Ancillary Care Services
Facility name
Hernando Medical Supply
Provider ID
P000005838
Tax ID
593662942
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Term Date
10/2/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
8340 Donal Street
Port Richey, FL 34668
United States
County
Pasco
Phone
7278624644 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address