Contract Details
Ancillary Care Services
Facility name
OMI Diagnostics
Provider ID
P000003772
NPI
1083628523
Tax ID
582165581
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
4586 Timber Ridge Drive Suite 100
Douglasville, GA 30135
United States
County
Douglas
Phone
7704894600 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address