Donna Lynn    Dyess    MD
Contract Details
USA Health System
Facility name
Provider ID
P000000463
NPI
1528012226
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
1660 Springhill Avenue Suite 3069
Mobile, AL 36617
United States
County
Mobile
Phone
2514458405 (Phone)
Billing Details
Address
P.O. Box 40480
Mobile, AL 36604
Specialty Type
Surgery, General
Map
Address