Contract Details
Ancillary Care Services
Facility name
Simonmed Imaging Florida
Provider ID
P000004644
NPI
1477830818
Tax ID
453727094
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
9582 West Colonial Drive
Ocoee, FL 34761
United States
County
Orange
Phone
4073636700 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address