Stephen  M  Foster    RPT
Contract Details
Champion Sports Medicine--Pelham-Gold's Gym
Facility name
Provider ID
P000000561
NPI
1073626206
Tax ID
721379381
Effective Date
3/1/1999
Last Updated
6/4/2014
Direct Contract
Yes
Term Date
2/17/2014
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
2244 Pelham Parkway Suite A
Pelham, AL 35124
United States
County
Shelby
Phone
2059888542 (Phone)
Billing Details
Address
P.O. Box 1245
Indiana, PA 15701
Billing Phone
7244653496
Specialty Type
Physical Therapy
Map
Address