Gregory  S  Borucki    DO
Contract Details
Russell Medical Center
Facility name
Provider ID
P000000172
NPI
1013995554
Tax ID
630385130
Effective Date
3/1/1999
Last Updated
6/10/2014
Direct Contract
Yes
Term Date
7/25/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
90.00
Location Details
Address
3316 Highway 280
Alexander City, AL 35010
United States
County
Tallapoosa
Phone
2563297100 (Phone)
Billing Details
Address
P.O. Box 939
Alexander City, AL 35011
Billing Phone
2563297109
Specialty Type
Emergency Medicine
Map
Address