D' Livro    Beauchamp    MD
Contract Details
Obelisk Healthcare, LLC
Facility name
Provider ID
P000000100
NPI
1205803327
Tax ID
134277516
Effective Date
11/15/2005
Last Updated
7/24/2020
Direct Contract
Yes
Term Date
7/24/2020
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
4705 Woodmere Boulevard
Montgomery, AL 36106
United States
County
Montgomery
Phone
3345580262 (Phone)
Billing Details
Address
4705 Woodmere Boulevard
Montgomery, AL 36106
Billing Phone
3345580262
Specialty Type
Urgent Care
Map
Address