Contract Details
Facility name
Nicl Laboratories
Provider ID
P000005022
NPI
1659373900
Tax ID
363485686
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
306 Era Drive
Northbrook, IL 60062
United States
County
Cook
Phone
8475099779 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address