Contract Details
Ancillary Care Services
Facility name
Prime Time Medical
Provider ID
P000004720
NPI
1518121854
Tax ID
262985681
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
7201 Bryan Dairy Road
Largo, FL 33777
United States
County
Pinellas
Phone
7275488386 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address