Contract Details
Ancillary Care Services
Facility name
Kentucky Prosthetics
Provider ID
P000004678
NPI
1497790851
Tax ID
610978304
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
339 South Preston Street
Louisville, KY 40202
United States
County
Jefferson
Phone
5025854228 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address