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
2103 Tebeau Street Suite B
Waycross, GA 31502
United States
County
Ware
Phone
9122832360 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address