Contract Details
Facility name
Advanced Imaging, Inc
Provider ID
P000004741
NPI
1528148715
Tax ID
752693862
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
3120 West South Lake Blvd Suite 140
Southlake, TX 76092
United States
County
Tarrant
Phone
8177410808 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address