Contract Details
Pomac Prosthetic & Orthotic Management
Facility name
Mountain Orthotic & Prosthetic Services
Provider ID
P000006309
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
7 Old Military Rd
Lake Placid, NY 12946
United States
County
Essex
Phone
5185232419 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address