Contract Details
Ancillary Care Services
Facility name
Professional Medical
Provider ID
P000005344
NPI
1780869057
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
1300 Stan Schlueter Loop Suite 300
Killeen, TX 76549
United States
County
Bell
Phone
2546804309 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address