Contract Details
Ancillary Care Services
Facility name
Orlando Foot & Ankle Clinic
Provider ID
P000005514
NPI
1871601112
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
650 South Courtenay Parkway Suite 200
Merritt Island, FL 32952
United States
County
Brevard
Phone
3212682020 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Podiatry
Map
Address