Contract Details
Ancillary Care Services
Facility name
Pramila Mitra Respiratory Services
Provider ID
P000005756
NPI
1982634259
Tax ID
522380049
Effective Date
4/1/2012
Last Updated
10/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
3306 Southwest 26th Avenue Suite 402
Ocala, FL 34471
United States
County
Marion
Phone
3522374545 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address