Contract Details
Ancillary Care Services
Facility name
OMI Diagnostics
Provider ID
P000005093
NPI
1689688178
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
2501 Chastain Meadows Parkway Suite C
Marietta, GA 30066
United States
County
Cobb
Phone
7707946700 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address