Bryan  I  Johnston    MD
Contract Details
Open Air MRI of Troy
Facility name
Provider ID
P000003527
NPI
1154428159
Tax ID
870704020
Effective Date
7/10/2012
Last Updated
8/19/2014
Direct Contract
Yes
Term Date
3/19/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
1001 South Franklin Drive
Troy, AL 36081
United States
County
Pike
Phone
3346700927 (Phone)
Billing Details
Address
P.O. Box 3711
Lake Charles, LA 70602
Billing Phone
3346700927
Specialty Type
Radiology, Diagnostic
Map
Address