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Donald
H
Dahlene
II
MD
Contract Details
Open Air MRI of Troy
Facility name
Provider ID
P000008189
NPI
1700861085
Tax ID
870704020
Effective Date
7/1/2012
Last Updated
3/2/2015
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
M
Exhibit ID
AM_154
AM_154
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