Contract Details
Ancillary Care Services
Facility name
Central Orthotics
Provider ID
P000004697
NPI
1508811225
Tax ID
582279826
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
304 Sunset Circle Suite A
Moultrie, GA 31768
United States
County
Colquitt
Phone
2298912636 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address