Patrick    Deheer    DPM
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005680
NPI
1942492814
Tax ID
352205377
Effective Date
4/1/2012
Last Updated
10/21/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
1101 West Jefferson Street Suite C
Franklin, IN 46131
United States
County
Johnson
Phone
3173467722 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Podiatry
Map
Address