Contract Details
TMC Orthopedic
Facility name
TMC Brace Place Southwest
Provider ID
P000005104
NPI
1689798050
Tax ID
760584487
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
990 IH 10 North Suite 113A
Beaumont, TX 77702
United States
County
Jefferson
Phone
4098922215 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address