Contract Details
Tasa
Facility name
Tasa
Provider ID
P000004221
NPI
1295853711
Tax ID
760325252
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
6535 Southwest Fwy
Houston, TX 77074
United States
County
Harris
Phone
7139818184 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address