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John
Ramsey
RPT
Contract Details
Fayette Medical Center
Facility name
Provider ID
P000001419
NPI
1245440650
Tax ID
636004942
Effective Date
11/5/1996
Last Updated
6/12/2014
Direct Contract
Yes
Term Date
6/12/2014
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
1653 Temple Avenue North
Fayette, AL 35555
United States
County
Fayette
Phone
2059325966
(
Phone
)
Billing Details
Address
809 University Boulevard East
Tuscaloosa, AL 35401
Billing Phone
2059325966
Specialty Type
Physical Therapy
Map
Address