Contract Details
Ancillary Care Services
Facility name
Wrencare
Provider ID
P000004171
NPI
1275550626
Tax ID
311641830
Effective Date
4/1/2012
Last Updated
10/21/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
235 West Grimme Lane
Bloomington, IN 47403
United States
County
Monroe
Phone
8123232884 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address