Contract Details
Facility name
HealthSouth Open MRI of Southlake
Provider ID
P000002189
NPI
1114976255
Tax ID
043687203
Effective Date
5/15/2003
Last Updated
6/10/2016
Direct Contract
Term Date
12/30/2013
Status
Contract Discounts
Discount Type
M
Exhibit ID
AM_100
Location Details
Address
4517 Southlake Parkway Suite 100
Birmingham, AL 35244
United States
County
Jefferson
Phone
2057338977 (Phone)
Billing Details
Address
P.O. Box 281206
Atlanta, GA 30384
Billing Phone
Specialty Type
Diagnostic Services
Map
Address