Contract Details
Ancillary Care Services
Facility name
Texas Healthcare Neck & Back Clinic
Provider ID
P000004591
NPI
1457460818
Tax ID
752599047
Effective Date
4/1/2012
Last Updated
11/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
4830 South Freeway
Fort Worth, TX 76115
United States
County
Tarrant
Phone
8179260012 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address