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Contract Details
Ancillary Care Services
Facility name
Mission Open MRI & Diagnostic Center
Provider ID
P000004515
NPI
1427141415
Tax ID
742984013
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
909 Business Park Drive Suite 1
Mission, TX 78572
United States
County
Hidalgo
Phone
9565858700
(
Phone
)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
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Address