Contract Details
Facility name
Champion Sports Medicine & Rehabilitation Center - Huntsville
Provider ID
P000002040
NPI
1528228905
Tax ID
382617193
Effective Date
3/1/1999
Last Updated
4/12/2018
Direct Contract
Yes
Term Date
8/14/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
5107 Moores Mill Road Suite C
Huntsville, AL 35811
United States
County
Madison
Phone
2568524622 (Phone)
Billing Details
Address
P.O. Box 1245
Indiana, PA 15701
Billing Phone
7244653496
Specialty Type
Physical Therapy
Map
Address