Karen  A  Fagan    MD
Contract Details
USA Health System
Facility name
Provider ID
P000000514
NPI
1053401737
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
2514705890 (Phone)
Billing Details
Address
P.O. Box 40480
Mobile, AL 36604
Specialty Type
Pulmonary Diseases
Map
Address