Contract Details
Pomac Prosthetic & Orthotic Management
Facility name
Certified Orthopedic Co, Inc
Provider ID
P000004995
NPI
1649241324
Tax ID
113154194
Effective Date
4/1/2012
Last Updated
5/21/2017
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
1904 Flatbush Avenue
Brooklyn, NY 11210
United States
County
Kings
Phone
7183381904 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address