Contract Details
Ancillary Care Services
Facility name
Momentum Medical Supply
Provider ID
P000004637
NPI
1477745016
Tax ID
260270333
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
6250 Westpark Drive Suite 113
Houston, TX 77057
United States
County
Harris
Phone
7133342300 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address