Contract Details
Ancillary Care Services
Facility name
Molecular Imaging Alliance
Provider ID
P000006429
Tax ID
260838608
Effective Date
4/1/2012
Last Updated
9/26/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
830 Suncrest Drive Suite 2
Gray, TN 37615
United States
County
Washington
Phone
4234773026 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address