Contract Details
Ancillary Care Services
Facility name
TJ Distributing
Provider ID
P000005956
Tax ID
392012203
Effective Date
4/1/2012
Last Updated
9/27/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
3021 Sandy Parkway Building 2, Suite R
Columbus, GA 31909
United States
County
Muscogee
Phone
2625138440 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address