Contract Details
Facility name
Stand - Up MRI of Elmhurst PC
Provider ID
P000004807
NPI
1558336420
Tax ID
113159217
Effective Date
6/28/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
7533 31st Ave
East Elmhurst, NY 11370
United States
County
Queens
Phone
7187792825 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address