Contract Details
Ancillary Care Services
Facility name
Suncoast Brace & Limb
Provider ID
P000003630
NPI
1013919307
Tax ID
650604632
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
301 South Citrus Avenue
Inverness, FL 34452
United States
County
Citrus
Phone
3527260111 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address