Contract Details
Ancillary Care Services
Facility name
Therapeutic Services
Provider ID
P000003966
NPI
1184611253
Tax ID
710721238
Effective Date
4/1/2012
Last Updated
10/21/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
500 South Mount Olive Street Suite 100
Siloam Springs, AR 72761
United States
County
Benton
Phone
4795246306 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address