Louis  S  Allison    MD
Contract Details
Institute For Total Eye Care--Selma
Facility name
Provider ID
P000000024
Tax ID
630940618
Effective Date
10/1/2002
Last Updated
5/5/2014
Direct Contract
Yes
Term Date
5/29/2013
Status
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
1025 Medical Center Parkway
Selma, AL 36701
United States
County
Dallas
Phone
3342779111 (Phone)
Billing Details
Address
4255 Carmichael Court North
Montgomery, AL 36106
Billing Phone
3342779111
Specialty Type
Ophthalmology
Map
Address