Contract Details
Ancillary Care Services
Facility name
Gulf Imaging Open MRI
Provider ID
P000005067
NPI
1679561526
Tax ID
030406301
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
406 West 19th Street
Panama City, FL 32405
United States
County
Bay
Phone
8507840545 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address