Contract Details
Facility name
Lehan Drug, Inc
Provider ID
P000004301
NPI
1336219419
Tax ID
362674647
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1407 South 4th St
DeKalb, IL 60115
United States
County
DeKalb
Phone
8157580911 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address