Contract Details
Ancillary Care Services
Facility name
Professional Medical
Provider ID
P000005020
NPI
1659339612
Tax ID
752545833
Effective Date
4/1/2012
Last Updated
11/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
4102 Buffalo Gap Road Suite J
Abilene, TX 79605
United States
County
Taylor
Phone
3256721585 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address