Contract Details
Ancillary Care Services
Facility name
Advanced Limb & Brace
Provider ID
P000004832
NPI
1568496479
Tax ID
202395634
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
5211 79th Street
Lubbock, TX 79424
United States
County
Lubbock
Phone
8067838388 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address