Contract Details
Ancillary Care Services
Facility name
Max S. Ribald & Associates
Provider ID
P000006628
Tax ID
751968873
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
909 9th Avenue Suite 200
Fort Worth, TX 76104
United States
County
Tarrant
Phone
8178609121 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Podiatry
Map
Address