Contract Details
Ancillary Care Services
Facility name
Southern Regional Open MRI
Provider ID
P000003949
NPI
1174526982
Tax ID
611319089
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
611 Hammond Plaza
Hopkinsville, KY 42240
United States
County
Christian
Phone
2708851950 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address