Contract Details
Ancillary Care Services
Facility name
Woodlake MRI & Diagnostic Imaging
Provider ID
P000006487
Tax ID
300106470
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
6671 Southwest Freeway Suite 105
Houston, TX 77074
United States
County
Harris
Phone
8322426200 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address