Contract Details
Ancillary Care Services
Facility name
Southern Clinical Laboratory
Provider ID
P000004426
NPI
1396751103
Tax ID
582016021
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
405 West Pike Street Suite A
Lawrenceville, GA 30046
United States
County
Gwinnett
Phone
7705134140 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address