Contract Details
Ancillary Care Services
Facility name
Westcoast Brace & Limb
Provider ID
P000005483
NPI
1861400491
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
2727 Martin Luther King, Jr. Boulevard
Tampa, FL 33607
United States
County
Hillsborough
Phone
8133540100 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Orthotics/Prosthetics, Services
Map
Address