Contract Details
Facility name
Superior DME, Inc
Provider ID
P000004621
NPI
1477545960
Tax ID
742942234
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
9207 Montana Suite B
El Paso, TX 79925
United States
County
El Paso
Phone
9157787959 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address