Contract Details
Ancillary Care Services
Facility name
MedCross Imaging
Provider ID
P000004215
NPI
1295780518
Tax ID
581393150
Effective Date
4/1/2012
Last Updated
9/27/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
842 Professional Center Drive
Eastman, GA 31023
United States
County
Dodge
Phone
4783744305 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address