Contract Details
Montclair Road Imaging, LLC
Facility name
ImageSouth Montclair Road
Provider ID
P000002209
NPI
1114998192
Tax ID
582545755
Effective Date
10/23/2018
Last Updated
2/10/2020
Direct Contract
No
Term Date
1/31/2020
Status
Contract Discounts
Discount Type
M
Exhibit ID
AM_434
Location Details
Address
924 Montclair Road Suite 108
Birmingham, AL 35213
United States
County
Jefferson
Phone
2055924674 (Phone)
Billing Details
Address
924 Montclair Road
Suite 108
Atlanta, GA 35213
Billing Phone
2055924674
Specialty Type
Diagnostic Services
Map
Address