Contract Details
Ancillary Care Services
Facility name
Range of Motion
Provider ID
P000004781
NPI
1548264997
Tax ID
582422031
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
526 Forest Parkway Suite H
Forest Park, GA 30297
United States
County
Clayton
Phone
7709914417 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address