Contract Details
Ancillary Care Services
Facility name
Dimensional Imaging
Provider ID
P000004971
NPI
1629183595
Tax ID
550840868
Effective Date
4/1/2012
Last Updated
10/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
5817 21st Avenue West Suite B
Bradenton, FL 34209
United States
County
Manatee
Phone
9419511888 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address