Contract Details
Ancillary Care Services
Facility name
Magnolia Respiratory Care
Provider ID
P000004695
NPI
1508808296
Tax ID
161655984
Effective Date
4/1/2012
Last Updated
10/18/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
600 East North Street
Magnolia, AR 71753
United States
County
Columbia
Phone
8665660404 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address