Contract Details
Ancillary Care Services
Facility name
Indian River Radiology
Provider ID
P000005084
NPI
1689616864
Tax ID
650341524
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1485 37th Street Suite 107
Vero Beach, FL 32960
United States
County
Indian River
Phone
7725699745 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address