Contract Details
Facility name
Streeterville Open MRI, LLC
Provider ID
P000004735
NPI
1518999614
Tax ID
721575655
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
446 East Ontario St Suite 106
Chicago, IL 60611
United States
County
Cook
Phone
3124400016 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address