Contract Details
Letourneau Lifelike Orthotics & Prosthetics
Facility name
Letourneau Prosthetics
Provider ID
P000005368
NPI
1790873685
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
1601 US 59
Livingston, TX 77351
United States
County
Polk
Phone
9363272115 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address