Contract Details
Ancillary Care Services
Facility name
Texas Healthcare Neck & Back Clinic
Provider ID
P000004641
NPI
1477766038
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
1005 West Jefferson Boulevard Suite 402
Dallas, TX 75208
United States
County
Dallas
Phone
2149431948 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address