Contract Details
Inmed Diagnostic Services
Facility name
Inmed Diagnostic Services of IL
Provider ID
P000004539
NPI
1437276508
Tax ID
331037226
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
10419 Fleming Rd
Carterville, IL 62918
United States
County
Williamson
Phone
6189858007 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address