Contract Details
Ancillary Care Services
Facility name
Tomball MS
Provider ID
P000005198
NPI
1720093545
Tax ID
680571014
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
701 South Persimmon Street Suite 25
Tomball, TX 77375
United States
County
Harris
Phone
2815167444 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address