Contract Details
Ancillary Care Services
Facility name
Mobile Quality Diagnostic
Provider ID
P000005502
NPI
1861652125
Tax ID
650640606
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
1751 West 38th Place Suite 1003-A
Hialeah, FL 33012
United States
County
Miami-Dade
Phone
3058208720 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address