Contract Details
Pomac Prosthetic & Orthotic Management
Facility name
General Orthopedic
Provider ID
P000005801
NPI
1053575431
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
1659 Central Ave
Albany, NY 12205
United States
County
Albany
Phone
5188690021 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address