Bradley    Thomas    MD
Contract Details
Southern Imaging Specialists
Facility name
Provider ID
P000000001
NPI
1740037542
Tax ID
203660940
Effective Date
3/1/2021
Last Updated
3/5/2021
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
M
Exhibit ID
AM_153
Location Details
Address
465 St. Lukes Drive
Montgomery, AL 36117
United States
Phone
334-279-8370 (Phone)
Billing Details
Address
P.O. Box 3711
Lake Charles, LA 70602
Billing Phone
334-279-8370
Specialty Type
Radiology, Diagnostic
Map
Address