Contract Details
Ancillary Care Services
Facility name
Select Diagnostics
Provider ID
P000004379
NPI
1376642827
Tax ID
562017400
Effective Date
4/1/2012
Last Updated
10/16/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
96.00
Location Details
Address
1800 South Hawthorne Road
Winston Salem, NC 27103
United States
County
Forsyth
Phone
3367681666 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address