Contract Details
Ancillary Care Services
Facility name
American Ortho-Tech Laboratories
Provider ID
P000004156
NPI
1265622781
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
938 Saxon Boulevard Suite 103
Orange City, FL 32763
United States
County
Volusia
Phone
3867751266 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address