John  B  Fiveash    MD
Contract Details
Russell Medical Center
Facility name
Provider ID
P000000544
NPI
1700820339
Tax ID
630385130
Effective Date
3/1/1999
Last Updated
6/10/2014
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
90.00
Location Details
Address
3446 Highway 280
Alexander City, AL 35010
United States
County
Tallapoosa
Phone
2563297888 (Phone)
Billing Details
Address
P.O. Box 939
Alexander City, AL 35011
Billing Phone
2563297109
Specialty Type
Radiation Oncology
Map
Address