Contract Details
Ancillary Care Services
Facility name
Rocky Mountain Therapy Services Texas
Provider ID
P000004482
NPI
1417240771
Tax ID
452307385
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1514 North Grandview Avenue
Odessa, TX 79761
United States
County
Ector
Phone
4325508777 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address