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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
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Address