Bruce    Pichler    DPM
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004023
NPI
1215008768
Tax ID
582114748
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1975 Beverly Road
Gainesville, GA 30501
United States
County
Hall
Phone
7705369908 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Podiatry
Map
Address