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Bradly
S
Goodman
MD
Contract Details
Alabama Orthopedic, Spine & Sports Medicine Associates
Facility name
Provider ID
P000000632
NPI
1295708584
Tax ID
630954295
Effective Date
2/15/1993
Last Updated
7/8/2016
Direct Contract
Yes
Term Date
9/24/2013
Status
W9 Attachment
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
1801 Gadsden Highway
Birmingham, AL 35235
United States
County
Jefferson
Phone
2058383900
(
Phone
)
Billing Details
Address
P.O. Box 830785
Drawer 415
Birmingham, AL 35283
Specialty Type
Physical Medicine & Rehabilitation
Map
Address