Contract Details
Facility name
Orthopedic Treatment Facility, Inc
Provider ID
P000004516
NPI
1427151448
Tax ID
112750831
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
4906 Queens Blvd
Woodside, NY 11377
United States
County
Queens
Phone
7188987326 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address