Lee    Goldstein    DPM
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000006144
Tax ID
611337860
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
8062 New La Grange Road
Louisville, KY 40222
United States
County
Jefferson
Phone
2706841660 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Podiatry
Map
Address