Contract Details
Ancillary Care Services
Facility name
Medina Valley Spine & Joint
Provider ID
P000005765
NPI
1982877825
Tax ID
261848434
Effective Date
4/1/2012
Last Updated
10/23/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
703 Highway 90 East Suite 107
Castroville, TX 78009
United States
County
Medina
Phone
8309312211 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address