Contract Details
Ancillary Care Services
Facility name
Sleep Center of Northwest Indiana
Provider ID
P000004178
NPI
1275622771
Tax ID
201384059
Effective Date
4/1/2012
Last Updated
10/21/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
7891 Broadway Suite G
Merrillville, IN 46410
United States
County
Lake
Phone
2197568000 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Sleep Medicine
Map
Address