Contract Details
Ancillary Care Services
Facility name
Vymed Diagnostic Imaging
Provider ID
P000005305
NPI
1770579732
Tax ID
200881710
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Term Date
9/30/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
885 Woodstock Road Suite 430
Roswell, GA 30075
United States
County
Fulton
Phone
8132647176 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address