Mary Jane    Hancock    CRNP
Contract Details
USA Health System
Facility name
Provider ID
P000000703
NPI
1417028903
Tax ID
630725648
Effective Date
9/25/2005
Last Updated
6/10/2016
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
2451 Fillingim Street
Mobile, AL 36617
United States
County
Mobile
Phone
2516658150 (Phone)
Billing Details
Address
P.O. Box 40480
Mobile, AL 36604
Specialty Type
Nurse Practitioner
Map
Address