Contract Details
Ancillary Care Services
Facility name
Angels Diagnostic Group
Provider ID
P000005150
NPI
1700108412
Tax ID
271427046
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
3900 Northwest 79th Avenue Suite 310
Doral, FL 33166
United States
County
Miami-Dade
Phone
3055938355 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address