Contract Details
Ancillary Care Services
Facility name
Portable Diagnostic Services
Provider ID
P000005004
NPI
1649337965
Tax ID
752512260
Effective Date
4/1/2012
Last Updated
11/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
72.00
Location Details
Address
3022 Motley Drive Suite 100
Mesquite, TX 75150
United States
County
Dallas
Phone
2143680101 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address