Contract Details
Ancillary Care Services
Facility name
Premier Medical Service
Provider ID
P000003684
NPI
1043287626
Tax ID
582219813
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1720 Windward Concourse Building 100
Alpharetta, GA 30005
United States
County
Fulton
Phone
7707814138 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address