Contract Details
Ancillary Care Services
Facility name
Prosthetic-Orthotic Associates of East Texas
Provider ID
P000005323
NPI
1780624148
Tax ID
752293443
Effective Date
4/1/2012
Last Updated
11/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
1122 East Front Street
Tyler, TX 75702
United States
County
Smith
Phone
9035926574 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address