William Brent    Faircloth    MD
Contract Details
Coastal Neurological Institute
Facility name
Provider ID
P000000516
NPI
1932100112
Tax ID
630782200
Effective Date
12/1/1999
Last Updated
2/7/2019
Direct Contract
Term Date
2/5/2019
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
90.00
Location Details
Address
3280 Dauphin Street Building A
Mobile, AL 36606
United States
County
Mobile
Phone
2514503700 (Phone)
Billing Details
Address
3280 Dauphin Street
Building A
Mobile, AL 36606
Billing Phone
Specialty Type
Surgery, Neurological
Map
Address