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Contract Details
Facility name
Alabama Orthopaedic Clinic, PC
Provider ID
P000001953
NPI
1487720355
Tax ID
631174582
Effective Date
7/1/2005
Last Updated
5/21/2017
Direct Contract
Yes
Term Date
4/16/2015
Status
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
220 Hospital Avenue
Jackson, AL 36545
United States
County
Clarke
Phone
2514103600
(
Phone
)
Billing Details
Address
3610 Springhill Memorial Drive North
Mobile, AL 36608
Billing Phone
2514103600
Specialty Type
Surgery, Orthopedic
Map
Address