Contract Details
Ancillary Care Services
Facility name
Broward Podiatry Associates
Provider ID
P000005428
NPI
1821082017
Tax ID
650537745
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
3816 Hollywood Boulevard Suite 206
Hollywood, FL 33021
United States
County
Broward
Phone
9549870550 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Podiatry
Map
Address