Contract Details
Ancillary Care Services
Facility name
The Butterfly Boutique
Provider ID
P000005171
NPI
1710161013
Tax ID
742424962
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1614 West Maple Avenue
McAllen, TX 78501
United States
County
Hidalgo
Phone
9566318636 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address