Contract Details
Ancillary Care Services
Facility name
Pom MRI & Imaging Center of Boca Raton
Provider ID
P000004861
NPI
1578592697
Tax ID
203725622
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
4373 West Sunrise Boulevard
Plantation, FL 33313
United States
County
Broward
Phone
9543180551 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address