Contract Details
Pomac Prosthetic & Orthotic Management
Facility name
Eastside Orthotics & Prosthetics
Provider ID
P000006389
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
889 Harrison Ave Suite 2A
Riverhead, NY 11901
United States
County
Suffolk
Phone
6317278735 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address