Contract Details
Ancillary Care Services
Facility name
FORME Medical & Rehab Center of Jacksonville
Provider ID
P000005592
NPI
1902983166
Tax ID
593703482
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
8773 Perimeter Park Court
Jacksonville, FL 32216
United States
County
Duval
Phone
5012799255 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address