Contract Details
Facility name
Chicago Ridge Radiology, SC
Provider ID
P000004785
NPI
1548282114
Tax ID
364405976
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
9830 Ridgeland Ave
Chicago Ridge, IL 60415
United States
County
Cook
Phone
7084231819 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address