Contract Details
Dothan Diagnostic Imaging, Inc.
Facility name
Dothan Diagnostic Imaging
Provider ID
P000009224
NPI
1528445145
Tax ID
473296778
Effective Date
9/17/2018
Last Updated
9/19/2018
Direct Contract
Yes
Term Date
9/18/2018
Status
Contract Discounts
Discount Type
M
Exhibit ID
AM_399
Location Details
Address
2240 W Main Street
Dothan, AL 36301
United States
County
Houston
Phone
3347921525 (Phone)
Billing Details
Address
2240 W Main Street
Dothan, AL 36301
Billing Phone
3347921525
Specialty Type
Diagnostic Services
Map
Address