Contract Details
Ancillary Care Services
Facility name
New Life Brace & Limb
Provider ID
P000006517
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
222 Parking Way
Lake Jackson, TX 77566
United States
County
Brazoria
Phone
2813165805 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address