Contract Details
Ancillary Care Services
Facility name
Sunrise Clinical Laboratory
Provider ID
P000003813
NPI
1093930919
Tax ID
201064340
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
21216 Olean Boulevard
Port Charlotte, FL 33952
United States
County
Charlotte
Phone
9416243005 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address