Contract Details
Ancillary Care Services
Facility name
Blueridge Diagnostic Imaging
Provider ID
P000003809
NPI
1093835100
Tax ID
611352898
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
103 Alycia Drive
Richmond, KY 40475
United States
County
Madison
Phone
8596263412 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address