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
Term Date
9/27/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
96.00
Location Details
Address
5112 Paulsen Street Suite 109
Savannah, GA 31405
United States
County
Chatham
Phone
9123527105 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address