Contract Details
Ancillary Care Services
Facility name
Eclipse Medical Imaging
Provider ID
P000004367
NPI
1366630196
Tax ID
364613667
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
6805 Northeast Loop 820 Suite 407
North Richland Hills, TX 76180
United States
County
Tarrant
Phone
8175814354 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address