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
601 South 4th Street Suite A
Gadsden, AL 35901
United States
County
Etowah
Phone
2565464300 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address