Contract Details
Ancillary Care Services
Facility name
MedMart
Provider ID
P000003932
NPI
1164422143
Tax ID
742260643
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
21195 IH 10 West Suite 1101
San Antonio, TX 78257
United States
County
Bexar
Phone
2106979933 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address