Wayne    Hurst    DPM
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004201
NPI
1285717199
Tax ID
742692446
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
1103 Rivery Boulevard Suite 255
Georgetown, TX 78628
United States
County
Williamson
Phone
5122593338 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Podiatry
Map
Address