Contract Details
Ancillary Care Services
Facility name
Oracle Diagnostic Laboratory
Provider ID
P000005197
NPI
1720090194
Tax ID
562017400
Effective Date
4/1/2012
Last Updated
10/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
96.00
Location Details
Address
270 Northwest Peacock Boulevard Suite 114
Port Saint Lucie, FL 34986
United States
County
Saint Lucie
Phone
7723232505 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address