Contract Details
Kelly's Medical Equipment & Supply
Facility name
Kelly's Medical Equipment & Supply
Provider ID
P000006056
NPI
1760650238
Tax ID
421482237
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
600 North College Avenue
Geneseo, IL 61254
United States
County
Henry
Phone
3099449797 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address