Carden  H  Cole    RPT
Contract Details
Champion Sports Medicine--Birmingham-Greystone
Facility name
Provider ID
P000000324
NPI
1588744817
Tax ID
382617193
Effective Date
3/1/1999
Last Updated
6/5/2014
Direct Contract
Yes
Term Date
1/15/2014
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
201 Doug Baker Boulevard
Birmingham, AL 35242
United States
County
Shelby
Phone
2054080700 (Phone)
Billing Details
Address
P.O. Box 1245
Indiana, PA 15701
Billing Phone
7244653496
Specialty Type
Physical Therapy
Map
Address