Contract Details
Ancillary Care Services
Facility name
Premier Medical Imaging
Provider ID
P000004092
NPI
1235466871
Tax ID
261289233
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
2055 North University Drive
Coral Springs, FL 33071
United States
County
Broward
Phone
9548250988 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address