Contract Details
Ancillary Care Services
Facility name
Laredo Open MRI
Provider ID
P000003954
NPI
1174612444
Tax ID
742836600
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
209 West Village Boulevard Suite 6
Laredo, TX 78041
United States
County
Webb
Phone
9567281177 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address