Contract Details
Ancillary Care Services
Facility name
Premier Sleep
Provider ID
P000004247
NPI
1316016918
Tax ID
742957616
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
111 North Park Drive
Victoria, TX 77901
United States
County
Victoria
Phone
3615729654 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Sleep Medicine
Map
Address