Contract Details
Ancillary Care Services
Facility name
Elite Imaging
Provider ID
P000005659
NPI
1942208319
Tax ID
651091915
Effective Date
4/1/2012
Last Updated
10/9/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
400 Arthur Godfrey Road Suite 103
Miami Beach, FL 33140
United States
County
Miami-Dade
Phone
3056922222 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address