Contract Details
Facility name
Upstate Rehabilitation Products
Provider ID
P000004962
NPI
1629018098
Tax ID
141649851
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
314 South Manning Blvd
Albany, NY 12208
United States
County
Albany
Phone
5188699372 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address