Contract Details
Ancillary Care Services
Facility name
Open MRI of Jackson
Provider ID
P000004149
NPI
1265528467
Tax ID
640923788
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
1 Layfair Drive Suite 315
Flowood, MS 39232
United States
County
Rankin
Phone
6019366500 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address