Contract Details
Ancillary Care Services
Facility name
Home Oxygen Medical Equipment
Provider ID
P000004966
NPI
1629072640
Tax ID
200301337
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
13881 Plantation Road Suite 5
Fort Myers, FL 33912
United States
County
Lee
Phone
8772813326 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address