Contract Details
Facility name
Bethpage Magnetic Resonance Imaging, PC
Provider ID
P000005511
NPI
1871547901
Tax ID
113061756
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
4273 Hempstead Tpke
Bethpage, NY 11714
United States
County
Nassau
Phone
5165795800 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address