Contract Details
Ancillary Care Services
Facility name
Professional Imaging Centers
Provider ID
P000005768
NPI
1982909123
Tax ID
050594854
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
1343 South International Parkway Suite 1351
Lake Mary, FL 32746
United States
County
Seminole
Phone
4073041000 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address