Contract Details
Facility name
Moody Diagnostic Inc
Provider ID
P000004509
NPI
1427101955
Tax ID
752796261
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
104 Trinity Pl
Palestine, TX 75801
United States
County
Anderson
Phone
9037235345 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address