Contract Details
Ancillary Care Services
Facility name
American Ortho-Tech Laboratories
Provider ID
P000004042
NPI
1215951983
Tax ID
592132244
Effective Date
9/27/2012
Last Updated
10/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
1320 Mason Avenue
Daytona Beach, FL 32117
United States
County
Volusia
Phone
3862580401 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address