Contract Details
Ancillary Care Services
Facility name
Durable Orthopaedic Supplies
Provider ID
P000004264
NPI
1316955693
Tax ID
742807189
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
1720 Murchison Drive
El Paso, TX 79902
United States
County
El Paso
Phone
9155322228 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address