Contract Details
Ancillary Care Services
Facility name
University Diagnostic Institute
Provider ID
P000004486
NPI
1417917253
Tax ID
593746972
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
111 North Lakemont Avenue
Winter Park, FL 32792
United States
County
Orange
Phone
4079753315 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address