Contract Details
Ancillary Care Services
Facility name
MedSource
Provider ID
P000005671
NPI
1942389127
Tax ID
364169028
Effective Date
4/1/2012
Last Updated
10/21/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
5739 Park Plaza Court
Indianapolis, IN 46220
United States
County
Marion
Phone
8885105100 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address