Contract Details
Ancillary Care Services
Facility name
Highland MRI
Provider ID
P000005771
NPI
1982925269
Tax ID
272366208
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
2946 Lakeland Highlands Road
Lakeland, FL 33803
United States
County
Polk
Phone
8635105944 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address