Contract Details
Ancillary Care Services
Facility name
Bostwick Laboratories
Provider ID
P000005509
NPI
1871526384
Tax ID
050593169
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
7001 Lake Ellenor Drive
Orlando, FL 32809
United States
County
Orange
Phone
4079920997 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address