Contract Details
Ancillary Care Services
Facility name
Regional Diagnostics
Provider ID
P000004872
NPI
1588652804
Tax ID
650718594
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
150 Southwest 12th Avenue Suite 102
Pompano Beach, FL 33069
United States
County
Broward
Phone
9547861180 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address