Contract Details
Ancillary Care Services
Facility name
Pamela A. Thompson, M.Ed., CCC-SP
Provider ID
P000005163
NPI
1700958725
Tax ID
254139215
Effective Date
4/1/2012
Last Updated
9/27/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
532 Stephenson Avenue Suite 100
Savannah, GA 31405
United States
County
Chatham
Phone
9123544474 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address