Contract Details
Ancillary Care Services
Facility name
Red Bank Radiology
Provider ID
P000003740
NPI
1063640514
Tax ID
262779227
Effective Date
4/1/2012
Last Updated
9/26/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1405 Hatcher Lane
Columbia, TN 38401
United States
County
Maury
Phone
9313886596 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address