Contract Details
Facility name
Prime Care Medical Supplies Inc
Provider ID
P000005490
NPI
1861486268
Tax ID
112604359
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
25 Corporate Dr
Holtsville, NY 11742
United States
County
Suffolk
Phone
6314470093 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address