Contract Details
Fast360, LLC
Facility name
Heritage Diagnostic Center
Provider ID
P000002191
NPI
1295788222
Tax ID
460926698
Effective Date
1/1/2017
Last Updated
5/21/2017
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
M
Exhibit ID
AM_312
Location Details
Address
1705 Main Avenue Southwest Suite C
Cullman, AL 35055
United States
County
Cullman
Phone
8666746728 (Phone)
Billing Details
Address
761 Old Hickory Boulevard
Suite 300
Brentwood, TN 37027
Billing Phone
8666746728
Specialty Type
Diagnostic Services
Map
Address