Contract Details
Ancillary Care Services
Facility name
Boland Prosthetic & Orthotic Center
Provider ID
P000003930
NPI
1164419743
Tax ID
582418393
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
110 Osigian Boulevard
Warner Robins, GA 31088
United States
County
Houston
Phone
4789532922 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address