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
1842 Simpson Highway 149
Mendenhall, MS 39114
United States
County
Simpson
Phone
6018472221 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address