Contract Details
Hedgecock Artificial Limb Co Inc
Facility name
Hedgecock Artificial Limb Co Inc
Provider ID
P000005141
NPI
1699967067
Tax ID
751230723
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1917 South Beckham
Tyler, TX 75701
United States
County
Smith
Phone
9035312228 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address