Contract Details
Ancillary Care Services
Facility name
LV Mobile Imaging
Provider ID
P000006536
Tax ID
205918937
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1504 Agate Drive
Weslaco, TX 78596
United States
County
Hidalgo
Phone
9565549729 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address