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Contract Details
Ancillary Care Services
Facility name
Gyn Path Services
Provider ID
P000005303
NPI
1770575938
Tax ID
742258912
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
8815 Dyer Street Suite 200
El Paso, TX 79904
United States
County
El Paso
Phone
9157558478
(
Phone
)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address