Contract Details
McKinney Prosthetics LLC
Facility name
McKinney Prosthetics LLC
Provider ID
P000004687
NPI
1497929434
Tax ID
383366373
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
460 North Front St Suite F
McHenry, IL 60050
United States
County
McHenry
Phone
8156796900 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address