Contract Details
Ancillary Care Services
Facility name
Indian River MRI
Provider ID
P000004025
NPI
1215049614
Tax ID
650588733
Effective Date
8/23/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
1850 37th Street
Vero Beach, FL 32960
United States
County
Indian River
Phone
7725623030 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address