Contract Details
Facility name
Medical Imaging Center
Provider ID
P000004117
NPI
1245480813
Tax ID
263275898
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
2500 West Higgins Rd Suite 830
Hoffman Estates, IL 60169
United States
County
Cook
Phone
8473108378 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address