Contract Details
Ancillary Care Services
Facility name
Doctors Laboratory
Provider ID
P000004460
NPI
1407850985
Tax ID
562017400
Effective Date
4/1/2012
Last Updated
10/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
96.00
Location Details
Address
224 Southpark Circle East
Saint Augustine, FL 32086
United States
County
Saint Johns
Phone
9048252350 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address