Jack  D  Denver    MD
Contract Details
Southeast Rehab Medicine
Facility name
Provider ID
P000000423
NPI
1154361343
Tax ID
630993240
Effective Date
3/1/1996
Last Updated
6/18/2018
Direct Contract
Yes
Term Date
12/31/2013
Status
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
3800 Ridgeway Drive Magnolia Hall
Birmingham, AL 35209
United States
County
Jefferson
Phone
2058682096 (Phone)
Billing Details
Address
P.O. Box 1223
Calera, AL 35040
Billing Phone
2056858040
Specialty Type
Physical Medicine & Rehabilitation
Map
Address