Contract Details
Academy Orthotic & Prosthetic Associates
Facility name
Academy / Modern Rehab Tech
Provider ID
P000006199
Tax ID
113193924
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
521 Route 111 Suite 104
Hauppauge, NY 11788
United States
County
Suffolk
Phone
8006692672 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address