Contract Details
Ancillary Care Services
Facility name
A1 Imaging of Orange Park
Provider ID
P000003718
NPI
1053570093
Tax ID
262562595
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
1566 Kingsley Avenue
Orange Park, FL 32073
United States
County
Clay
Phone
9042782128 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address