Contract Details
Facility name
Prime Medical Supply Corporation
Provider ID
P000005557
NPI
1891761615
Tax ID
113254634
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
5723 New Utrecht Ave
Brooklyn, NY 11219
United States
County
Kings
Phone
7184370066 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address