Contract Details
Facility name
Houston Stat Medical Supply and Equipment
Provider ID
P000004217
NPI
1295794808
Tax ID
770606927
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
12302 Van Buren St Suite A-1
Houston, TX 77064
United States
County
Harris
Phone
7137790644 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address