Contract Details
Open Advanced MRI
Facility name
Open Advanced MRI of Crystal Lake, LLC
Provider ID
P000003803
NPI
1093770851
Tax ID
541998360
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
820 East Terra Cotta Ave Suite 136
Crystal Lake, IL 60014
United States
County
McHenry
Phone
8154441330 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address