Contract Details
Ancillary Care Services
Facility name
Providacare Medical Supply
Provider ID
P000003687
NPI
1043326481
Tax ID
204085768
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
3453 IH 35 North Suite 210
San Antonio, TX 78219
United States
County
Bexar
Phone
2102268700 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address