Contract Details
Ancillary Care Services
Facility name
Orlando Foot & Ankle Clinic
Provider ID
P000003711
NPI
1053420836
Tax ID
592580012
Effective Date
4/1/2012
Last Updated
10/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
835 7th Street Suite 6
Clermont, FL 34711
United States
County
Lake
Phone
3522437066 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Podiatry
Map
Address