Contract Details
Fast360, LLC
Facility name
ImageSouth Montclair Road
Provider ID
P000002209
NPI
1114998192
Tax ID
460926698
Effective Date
1/1/2017
Last Updated
2/10/2020
Direct Contract
No
Term Date
1/31/2020
Status
Contract Discounts
Discount Type
M
Exhibit ID
AM_312
Location Details
Address
924 Montclair Road Suite 108
Birmingham, AL 35213
United States
County
Jefferson
Phone
8666746728 (Phone)
Billing Details
Address
924 Montclair Road
Suite 108
Brentwood, TN 35213
Billing Phone
8666746728
Specialty Type
Diagnostic Services
Map
Address