Contract Details
Ancillary Care Services
Facility name
Numed Imaging Center
Provider ID
P000004543
NPI
1437329521
Tax ID
752577465
Effective Date
4/1/2012
Last Updated
11/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
1101 6th Avenue
Fort Worth, TX 76104
United States
County
Tarrant
Phone
8173364638 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address