Contract Details
Pomac Prosthetic & Orthotic Management
Facility name
Champlain Valley Brace & Limb
Provider ID
P000006238
Tax ID
113154194
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
762 Airport Plz Suite 15
Plattsburgh, NY 12901
United States
County
Clinton
Phone
5185617343 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address