Contract Details
Ancillary Care Services
Facility name
Texas Medical Diagnostics
Provider ID
P000005366
NPI
1790863702
Tax ID
752465638
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
908 West Terrell Avenue North
Fort Worth, TX 76104
United States
County
Tarrant
Phone
8178200427 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Sleep Medicine
Map
Address