Contract Details
Open Advanced MRI
Facility name
Open Advanced MRI of Wheaton
Provider ID
P000005280
NPI
1760447502
Tax ID
541909528
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
43 Danada Square East
Wheaton, IL 60187
United States
County
DuPage
Phone
6305107050 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address