Contract Details
Lincare
Facility name
Southeast IV Home Care
Provider ID
P000002414
NPI
1376607143
Tax ID
592852900
Effective Date
4/1/1998
Last Updated
9/22/2014
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
M
Exhibit ID
AM_103
Location Details
Address
241 Winton M. Blount Loop
Montgomery, AL 36117
United States
County
Montgomery
Phone
3342727000 (Phone)
Billing Details
Address
19387 Highway 19 North
Clearwater, FL 33764
Billing Phone
7274318110
Specialty Type
Home Infusion
Map
Address