Contract Details
Ancillary Care Services
Facility name
Prism Medical Products
Provider ID
P000004794
NPI
1548367063
Tax ID
753221011
Effective Date
4/1/2012
Last Updated
10/18/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2950 Old Nation Road Suite 9
Fort Mill, SC 29715
United States
County
York
Phone
8009756321 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address