Contract Details
Ancillary Care Services
Facility name
South Texas Medical Supply
Provider ID
P000004578
NPI
1457366296
Tax ID
742963697
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
4410 Dillon Lane Suite 18
Corpus Christi, TX 78415
United States
County
Nueces
Phone
3618542720 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address