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
1699 Periwinkle Way
Sanibel, FL 33957
United States
County
Lee
Phone
2394724165 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address