Contract Details
Facility name
Medical Imaging Center of Nacogdoches
Provider ID
P000004485
NPI
1417912544
Tax ID
200621291
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
96.00
Location Details
Address
4932 North St
Nacogdoches, TX 75965
United States
County
Nacogdoches
Phone
9364629909 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address