Contract Details
Premier Health Imaging
Facility name
MRI River North
Provider ID
P000004262
NPI
1316949886
Tax ID
364072911
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
664 North Wells St
Chicago, IL 60654
United States
County
Cook
Phone
3123351155 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address