Contract Details
Lister Healthcare Corporation
Facility name
Ardmore Clinic
Provider ID
P000002001
NPI
1922044494
Tax ID
636002175
Effective Date
10/5/2000
Last Updated
6/10/2014
Direct Contract
Yes
Term Date
11/22/2013
Status
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
26545 1st Street
Ardmore, AL 35739
United States
County
Limestone
Phone
2564234800 (Phone)
Billing Details
Address
P.O. Box 700
Ardmore, TN 38449
Billing Phone
2564234800
Specialty Type
Family Practice
Map
Address