Contract Details
Ancillary Care Services
Facility name
Prescott's Orthotics & Prosthetics
Provider ID
P000004326
NPI
1346302809
Tax ID
741915839
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
810 North Llano Street
Fredericksburg, TX 78624
United States
County
Gillespie
Phone
8309908925 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address