Contract Details
Facility name
Champion Sports Medicine & Rehabilitation Center - Livingston
Provider ID
P000002041
NPI
1982813234
Tax ID
382617193
Effective Date
3/1/1999
Last Updated
4/12/2018
Direct Contract
Term Date
8/14/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
1 College Drive
Livingston, AL 35470
United States
County
Sumter
Phone
2056523714 (Phone)
Billing Details
Address
P.O. Box 1245
Indiana, PA 15701
Billing Phone
Specialty Type
Physical Therapy
Map
Address