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
310 Ellis Street
Carthage, MS 39051
United States
County
Leake
Phone
6012671149 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address