Contract Details
Ancillary Care Services
Facility name
Sure Test Laboratory
Provider ID
P000003791
NPI
1083806178
Tax ID
010975715
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
4609 County Road 919
Crowley, TX 76036
United States
County
Tarrant
Phone
8174269355 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address