Contract Details
Ancillary Care Services
Facility name
New Life Brace & Limb
Provider ID
P000004685
NPI
1497895817
Tax ID
204877969
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
250 Blossom Street Suite 200
Webster, TX 77598
United States
County
Harris
Phone
2813165805 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address