Charles  H  Clark  III  MD
Contract Details
Neurosurgical Associates
Facility name
Provider ID
P000000309
NPI
1033206065
Tax ID
630576431
Effective Date
3/9/1992
Last Updated
8/16/2018
Direct Contract
Term Date
8/13/2018
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
90.00
Location Details
Address
1948 Highway 157 Building 1, Suite 430
Cullman, AL 35055
United States
County
Cullman
Phone
2567372540 (Phone)
Billing Details
Address
800 Saint Vincent's Drive
Suite 700
Birmingham, AL 35205
Billing Phone
Specialty Type
Surgery, Neurological
Map
Address