Amy  L  Illescas    MD
Contract Details
American Family Care--Alabaster
Facility name
Provider ID
P000000821
NPI
1346269123
Tax ID
630825248
Effective Date
7/1/2011
Last Updated
5/27/2014
Direct Contract
Yes
Term Date
9/12/2011
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
120 Colonial Promenade Parkway
Alabaster, AL 35007
United States
County
Shelby
Phone
2056050495 (Phone)
Billing Details
Address
P.O. Box 830810
Birmingham, AL 35283
Billing Phone
Specialty Type
Internal Medicine
Map
Address