Contract Details
Ancillary Care Services
Facility name
Los Alamos Imaging Center
Provider ID
P000005501
NPI
1861639635
Tax ID
263858485
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
427 East Duranta Avenue Suite 100
Alamo, TX 78516
United States
County
Hidalgo
Phone
9567815872 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address