Contract Details
Ancillary Care Services
Facility name
Mayfair Laboratory
Provider ID
P000005362
NPI
1790839223
Tax ID
611206747
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
2315 Mayfair Drive Suite 1
Owensboro, KY 42301
United States
County
Daviess
Phone
2706846212 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address