Contract Details
Ancillary Care Services
Facility name
Scott Medical Imaging
Provider ID
P000005589
NPI
1902917099
Tax ID
640868263
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
730 Ridgewood Road Suite C
Ridgeland, MS 39157
United States
County
Madison
Phone
6012065605 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address