Contract Details
Montclair Road Imaging, LLC
Facility name
ImageSouth Montclair Road
Provider ID
P000002209
NPI
1114998192
Tax ID
582545755
Effective Date
10/2/2000
Last Updated
4/26/2017
Direct Contract
Term Date
4/19/2017
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
924 Montclair Road Suite 108
Birmingham, AL 35213
United States
County
Jefferson
Phone
2055924674 (Phone)
Billing Details
Address
P.O. Box 931108
Atlanta, GA 31193
Billing Phone
Specialty Type
Diagnostic Services
Map
Address