Contract Details
Ancillary Care Services
Facility name
Bostwick Laboratories
Provider ID
P000005700
NPI
1952465288
Tax ID
050593169
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
4851 Lake Brook Drive
Glen Allen, VA 23060
United States
County
Henrico
Phone
8049679225 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address