Contract Details
Pomac Prosthetic & Orthotic Management
Facility name
We Fit Well
Provider ID
P000005816
NPI
1568497071
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
3557 East Tremont Ave
Bronx, NY 10465
United States
County
Bronx
Phone
7188285007 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address