Contract Details
Ancillary Care Services
Facility name
Lubbock CT
Provider ID
P000003702
NPI
1043594179
Tax ID
452830012
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
3711 20th Street
Lubbock, TX 79410
United States
County
Lubbock
Phone
8066872989 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address