Contract Details
Kelly's Medical Equipment & Supply
Facility name
Kelly's Medical Equipment & Supply
Provider ID
P000005660
NPI
1942231287
Tax ID
204923059
Effective Date
4/1/2012
Last Updated
5/21/2017
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
1968 North Henderson Street
Galesburg, IL 61401
United States
County
Knox
Phone
3093411117 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address