Contract Details
Ancillary Care Services
Facility name
Sun City Medical Supply
Provider ID
P000005015
NPI
1659304020
Tax ID
043699926
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1530 Goodyear Drive Suite A-1
El Paso, TX 79936
United States
County
El Paso
Phone
9155907008 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address