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Noris
M
Keating
MD
Contract Details
AmeriPath
Facility name
Provider ID
P000006727
NPI
1023096021
Tax ID
650641688
Effective Date
5/16/2012
Last Updated
5/21/2017
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
8150 Chancellor Drive Suite 110
Orlando, FL 328097665
United States
County
Orange
Phone
8003957284
(
Phone
)
Billing Details
Address
16684 Collections Center Drive
Chicago, IL 606930166
Billing Phone
8668367136
Specialty Type
Pathology, Clinical
Map
Address