Contract Details
Ancillary Care Services
Facility name
Weaver Home Medical
Provider ID
P000005243
NPI
1740425933
Tax ID
264600950
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
3700 West Way Street
Tyler, TX 75703
United States
County
Smith
Phone
9035974363 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address