Contract Details
Ancillary Care Services
Facility name
Freedom Orthotics & Prosthetics
Provider ID
P000004922
NPI
1609036797
Tax ID
562670452
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
840 FM 1960 West Suite 5
Houston, TX 77090
United States
County
Harris
Phone
2815808228 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address