Contract Details
Facility name
Bridgeway Diagnostic Radiology
Provider ID
P000008280
NPI
1306248729
Tax ID
471579306
Effective Date
5/19/2015
Last Updated
7/15/2015
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
5007 Summerville Road
Phenix City, AL 36867
United States
County
Russell
Phone
3344082854 (Phone)
Billing Details
Address
P.O. Box 242848
Montgomery, AL 36124
Billing Phone
3343869357
Specialty Type
Diagnostic Services
Map
Address