Contract Details
Facility name
Ortho Shoes Corp
Provider ID
P000004137
NPI
1255668737
Tax ID
270556762
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
9836 Queens Blvd
Rego Park, NY 11374
United States
County
Queens
Phone
7182750018 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address