Contract Details
Ancillary Care Services
Facility name
Professional Home Oxygen Service
Provider ID
P000004613
NPI
1467622613
Tax ID
742971233
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
104 West Marcy Drive
Big Spring, TX 79720
United States
County
Howard
Phone
8067911188 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address