Scott  W  LeCroy    MD
Contract Details
Simon-Williamson Clinic
Facility name
Provider ID
P000000977
NPI
1376563585
Tax ID
630693892
Effective Date
3/1/1999
Last Updated
6/9/2016
Direct Contract
Yes
Term Date
8/26/2013
Status
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
832 Princeton Avenue Southwest
Birmingham, AL 35211
United States
County
Jefferson
Phone
2057807053 (Phone)
Billing Details
Address
832 Princeton Avenue Southwest
Birmingham, AL 35211
Billing Phone
2057807053
Specialty Type
Ophthalmology
Map
Address