Contract Details
Pomac Prosthetic & Orthotic Management
Facility name
Sampson Prosthetic & Orthotic Laboratory
Provider ID
P000005824
NPI
1790990315
Tax ID
113154194
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
17 Main St
Queensbury, NY 12804
United States
County
Warren
Phone
5183746011 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address