Contract Details
Pomac Prosthetic & Orthotic Management
Facility name
Northern Orthopedic Lab
Provider ID
P000006395
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
500 State St
Ogdensburg, NY 13669
United States
County
Saint Lawrence
Phone
3153934502 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address