Contract Details
Ancillary Care Services
Facility name
Theratech
Provider ID
P000004965
NPI
1629071352
Tax ID
621649802
Effective Date
4/1/2012
Last Updated
9/16/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
1109 Myatt Boulevard
Madison, TN 37115
United States
County
Davidson
Phone
6158654000 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address