Contract Details
Ancillary Care Services
Facility name
Florida Radiology
Provider ID
P000004729
NPI
1518907823
Tax ID
030420417
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
96.00
Location Details
Address
63 Barkley Circle Suite 100
Fort Myers, FL 33907
United States
County
Lee
Phone
2399383571 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address