Contract Details
Ancillary Care Services
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
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
11921 Freedom Drive Suite 980
Reston, VA 20190
United States
County
Fairfax
Phone
7039702892 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address