Contract Details
Facility name
Physician Laboratory Services
Provider ID
P000005320
NPI
1780600510
Tax ID
753051169
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
2015 Jackson Creek Ave
Edinburg, TX 78539
United States
County
Hidalgo
Phone
9563801203 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address