Contract Details
Ancillary Care Services
Facility name
Dominion Diagnostics
Provider ID
P000005605
NPI
1912903717
Tax ID
541882269
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
2001 North Mays Street Suite 3
Round Rock, TX 78664
United States
County
Williamson
Phone
2104883670 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address