Contract Details
Ancillary Care Services
Facility name
Blue Star Imaging
Provider ID
P000005300
NPI
1770543365
Tax ID
201137664
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
One Cowboys Parkway
Irving, TX 75063
United States
County
Dallas
Phone
2146476154 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address