Contract Details
Ancillary Care Services
Facility name
Heart Study Center
Provider ID
P000004175
NPI
1275590192
Tax ID
593444646
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
755 West State Road 434 Suite A
Longwood, FL 32750
United States
County
Seminole
Phone
4078341151 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address