Contract Details
Facility name
Tristate Sleep Clinic
Provider ID
P000005009
NPI
1649417213
Tax ID
263336585
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
3710 Pennsylvania Ave Suite B
Weirton, WV 26062
United States
County
Hancock
Phone
3042241230 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Sleep Medicine
Map
Address