Bryan  I  Johnston    MD
Contract Details
Southern Imaging Specialists
Facility name
Provider ID
P000003527
NPI
1154428159
Tax ID
203660940
Effective Date
7/10/2012
Last Updated
8/19/2014
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
M
Exhibit ID
AM_153
Location Details
Address
465 Saint Lukes Drive
Montgomery, AL 36117
United States
County
Montgomery
Phone
3342798370 (Phone)
Billing Details
Address
P.O. Box 3711
Lake Charles, LA 70602
Billing Phone
3342798370
Specialty Type
Radiology, Diagnostic
Map
Address