Contract Details
Ancillary Care Services
Facility name
GM Diagnostics
Provider ID
P000005144
NPI
1700046901
Tax ID
262550188
Effective Date
4/1/2012
Last Updated
10/23/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
4712 Thorntree Drive
Plano, TX 75024
United States
County
Collin
Phone
4698774846 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address