Contract Details
Ancillary Care Services
Facility name
Elite Clinical Laboratory
Provider ID
P000005681
NPI
1942503412
Tax ID
272896871
Effective Date
4/30/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1917 Ashland Street Suite 120
Houston, TX 77008
United States
County
Harris
Phone
7136911654 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address