Contract Details
Facility name
Suffolk MRI
Provider ID
P000005667
NPI
1942261128
Tax ID
112736143
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
987 West Jericho Tpke
Smithtown, NY 11787
United States
County
Suffolk
Phone
6318649100 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address