Contract Details
Bethpage Magnetic Resonance Imaging, PC
Facility name
Bethpage MRI
Provider ID
P000005603
NPI
1912236605
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
4277 Hempstead Tpke Suite 200
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