Kerry    Richardson    RPT
Contract Details
Fayette Medical Center
Facility name
Provider ID
P000001459
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