Contract Details
Facility name
Letourneau Lifelike Orthotics & Prosthetics
Provider ID
P000004468
NPI
1407951510
Tax ID
760464959
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
2452 Calder Ave
Beaumont, TX 77702
United States
County
Jefferson
Phone
4098325005 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address