Contract Details
Ancillary Care Services
Facility name
Echocardiogram
Provider ID
P000003766
NPI
1073803805
Tax ID
264766295
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
2000 North Loop West Suite 100
Houston, TX 77018
United States
County
Harris
Phone
7135790655 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address