Contract Details
Ancillary Care Services
Facility name
Southern Open MRI
Provider ID
P000003600
NPI
1003819822
Tax ID
582367898
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
3685 Wheeler Road Suite 100
Augusta, GA 30909
United States
County
Richmond
Phone
7068699000 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address