Patrick    Deheer    DPM
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000006125
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
2545 Foxpointe Drive Suite E
Columbus, IN 47203
United States
County
Bartholomew
Phone
8123783668 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Podiatry
Map
Address