Contract Details
Ancillary Care Services
Facility name
Lincoln Trail Diagnostics
Provider ID
P000005535
NPI
1881697613
Tax ID
611379103
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
1111 Woodland Drive
Elizabethtown, KY 42701
United States
County
Hardin
Phone
2707653700 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address