Contract Details
Ancillary Care Services
Facility name
Southern Home Respiratory And Equipment
Provider ID
P000005460
NPI
1841230653
Tax ID
593769111
Effective Date
4/1/2012
Last Updated
10/16/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
282 Westgate Mall Circle Suite 117
Pennington Gap, VA 24277
United States
County
Lee
Phone
3039058527 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address