Contract Details
Tasa
Facility name
Tasa
Provider ID
P000005590
NPI
1902924525
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
6969 Gulf Fwy Suite 370
Houston, TX 77087
United States
County
Harris
Phone
7136430600 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address