Contract Details
Facility name
Gulf Coast Open MRI Unit Ltd
Provider ID
P000005427
NPI
1821056474
Tax ID
760690406
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
3790 Memorial Blvd
Port Arthur, TX 77640
United States
County
Jefferson
Phone
4099854000 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address