Contract Details
Ancillary Care Services
Facility name
Mahnke's Orthotics & Prosthetics
Provider ID
P000003931
NPI
1164420766
Tax ID
592066233
Effective Date
4/1/2012
Last Updated
10/1/2013
Direct Contract
No
Term Date
10/1/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
74.00
Location Details
Address
4050 Northeast 5th Avenue Suite A
Oakland Park, FL 33334
United States
County
Broward
Phone
9547721299 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address