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Contract Details
Facility name
ConservCare, Inc.
Provider ID
P000002062
NPI
1811211600
Tax ID
593051846
Effective Date
7/15/2008
Last Updated
3/4/2022
Direct Contract
Yes
Term Date
2/28/2022
Status
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
6925 Lake Ellenor Drive Suite 600
Orlando, FL 32809
United States
County
Orange
Phone
4072408428
(
Phone
)
Billing Details
Address
6925 Lake Ellenor Drive
Suite 600
Orlando, FL 32809
Specialty Type
Orthotics/Prosthetics, Services
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Address