Contract Details
Ancillary Care Services
Facility name
Weslaco Advanced Medical Imaging
Provider ID
P000004052
NPI
1225081748
Tax ID
742967281
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
1125 South James Street
Weslaco, TX 78596
United States
County
Hidalgo
Phone
9569739696 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address