Contract Details
Ancillary Care Services
Facility name
Doctors Laboratory
Provider ID
P000004460
NPI
1407850985
Tax ID
562017400
Effective Date
4/1/2012
Last Updated
9/27/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
96.00
Location Details
Address
1601 Fair Road Suite 700
Statesboro, GA 30458
United States
County
Bulloch
Phone
9128714525 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address