Contract Details
Facility name
Dominion Diagnostics
Provider ID
P000005605
NPI
1912903717
Tax ID
541882269
Effective Date
4/1/2012
Last Updated
9/27/2013
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
799 Roosevelt Road Building 6, Suite D
Glen Ellyn, IL 60137
United States
County
DuPage
Phone
6308174249 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address