Contract Details
Ancillary Care Services
Facility name
Mid Florida Imaging
Provider ID
P000004659
NPI
1487750949
Tax ID
593572096
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
1150 South Semoran Boulevard Suite D
Orlando, FL 32807
United States
County
Orange
Phone
4074825253 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address