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Joseph
Wall
III
MD
Contract Details
Open MRI of Jasper
Facility name
Provider ID
P000001812
Tax ID
202513140
Effective Date
3/1/2006
Last Updated
6/10/2016
Direct Contract
Yes
Term Date
6/24/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
301 North Walston Bridge Road Suite 104
Jasper, AL 35504
United States
County
Walker
Phone
2053870977
(
Phone
)
Billing Details
Address
P.O. Box 2153
Department 5111
Birmingham, AL 35287
Specialty Type
Radiology, Diagnostic
Map
Address