Contract Details
Letourneau Lifelike Orthotics & Prosthetics
Facility name
Letourneau Prosthetics
Provider ID
P000003862
NPI
1124116025
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
3516 Hwy 365
Nederland, TX 77627
United States
County
Jefferson
Phone
4097222163 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address