Contract Details
Facility name
SOS Medical Supplies Ltd
Provider ID
P000004680
NPI
1497825731
Tax ID
760577564
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
4450 West 12th St
Houston, TX 77055
United States
County
Harris
Phone
7139574848 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address