Contract Details
Ancillary Care Services
Facility name
Valley Medical Depot
Provider ID
P000005054
NPI
1669587515
Tax ID
201258306
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
5510 South Jackson Road
Edinburg, TX 78539
United States
County
Hidalgo
Phone
9566826769 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address