Contract Details
Facility name
Sleep Diagnostic Center
Provider ID
P000005536
NPI
1881707891
Tax ID
364097412
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2522 West Peterson Ave
Chicago, IL 60659
United States
County
Cook
Phone
7732624110 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Sleep Medicine
Map
Address