Contract Details
Ancillary Care Services
Facility name
Westcoast Radiology
Provider ID
P000004626
NPI
1477560514
Tax ID
593456023
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
1193 Black Wood Avenue
Ocoee, FL 34761
United States
County
Orange
Phone
7274466760 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address