Contract Details
Facility name
Champion Sports Medicine & Rehabilitation Center - St. Vincent's
Provider ID
P000002045
NPI
1861401481
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
85.00
Location Details
Address
805 St. Vincent's Drive Suite G-100
Birmingham, AL 35205
United States
County
Jefferson
Phone
2059391557 (Phone)
Billing Details
Address
P.O. Box 1245
Indiana, PA 15701
Billing Phone
7244653496
Specialty Type
Physical Therapy
Map
Address