Contract Details
Facility name
Advantage MRI - Logan Square
Provider ID
P000004597
NPI
1467408872
Tax ID
203757504
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
2008 North Pulaski Rd
Chicago, IL 60639
United States
County
Cook
Phone
7732279777 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address