Contract Details
Ancillary Care Services
Facility name
Family Podiatry Group
Provider ID
P000004368
NPI
1366650160
Tax ID
592981304
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
7926 West Hillsborough Avenue Suite G
Tampa, FL 33615
United States
County
Hillsborough
Phone
8138869180 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Podiatry
Map
Address