Contract Details
Facility name
Advantage Imaging
Provider ID
P000005379
NPI
1790986388
Tax ID
208306685
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
4351 North Cicero Ave
Chicago, IL 60641
United States
County
Cook
Phone
7734271222 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address