Melanie  H  Clark    MD
Contract Details
USA Health System
Facility name
Provider ID
P000000307
NPI
1164692711
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
1600 Springhill Avenue
Mobile, AL 36604
United States
County
Mobile
Phone
2516658000 (Phone)
Billing Details
Address
P.O. Box 40480
Mobile, AL 36604
Specialty Type
Radiology, Diagnostic
Map
Address