Contract Details
Ancillary Care Services
Facility name
Orlando Foot & Ankle Clinic
Provider ID
P000004063
NPI
1225215270
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
3670 Maguire Boulevard Suite 220
Orlando, FL 32803
United States
County
Orange
Phone
4074231234 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Podiatry
Map
Address