Contract Details
Ancillary Care Services
Facility name
Diagnostic Ultrasound Consultants
Provider ID
P000004994
NPI
1639369531
Tax ID
621072884
Effective Date
4/1/2012
Last Updated
9/26/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
188 South Bellevue Boulevard Suite 222
Memphis, TN 38104
United States
County
Shelby
Phone
9018482689 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address