Contract Details
Ancillary Care Services
Facility name
Southern Diagnostic Laboratory
Provider ID
P000004456
NPI
1407806144
Tax ID
270058255
Effective Date
4/1/2012
Last Updated
1/9/2014
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
96.00
Location Details
Address
2018 Brookwood Medical Center Drive
Birmingham, AL 35209
United States
County
Jefferson
Phone
2058703887 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address