Contract Details
Ancillary Care Services
Facility name
Mid Florida Imaging
Provider ID
P000005290
NPI
1760588230
Tax ID
261289233
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
819 East Oak Street Suite C
Kissimmee, FL 34744
United States
County
Osceola
Phone
4079320224 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address