Contract Details
Ancillary Care Services
Facility name
Round Rock Orthotics & Prosthetics
Provider ID
P000004503
NPI
1427059203
Tax ID
742978087
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
555 Round Rock West Drive Suite 100
Round Rock, TX 78681
United States
County
Williamson
Phone
5123413700 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address