Contract Details
Ancillary Care Services
Facility name
Coastline Imaging
Provider ID
P000005304
NPI
1770576167
Tax ID
650774532
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
2290 West Eau Gallie Boulevard Suite 104
Melbourne, FL 32935
United States
County
Brevard
Phone
3212532700 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address