Contract Details
Ancillary Care Services
Facility name
Westcoast Brace & Limb
Provider ID
P000003991
NPI
1194733758
Tax ID
592066601
Effective Date
4/1/2012
Last Updated
10/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
4021 Central Avenue Suite C
Saint Petersburg, FL 33713
United States
County
Pinellas
Phone
7273239500 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address