Contract Details
Facility name
Southern Imaging Specialists
Provider ID
P000002422
NPI
1962468256
Tax ID
203660940
Effective Date
5/16/2012
Last Updated
8/19/2014
Direct Contract
Yes
Term Date
3/19/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
465 Saint Lukes Drive
Montgomery, AL 36117
United States
County
Montgomery
Phone
3342798370 (Phone)
Billing Details
Address
P.O. Box 3711
Lake Charles, LA 70602
Billing Phone
3342798370
Specialty Type
Diagnostic Services
Map
Address