Contract Details
Medsource LLC
Facility name
Medsource, LLC
Provider ID
P000005634
NPI
1922264159
Tax ID
364169028
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
2400 86th St Suite 23
Des Moines, IA 50322
United States
County
Polk
Phone
8885105100 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address