Contract Details
Facility name
Coastal Therapeutics
Provider ID
P000002056
NPI
1356434906
Tax ID
753039795
Effective Date
11/1/2003
Last Updated
3/4/2022
Direct Contract
Yes
Term Date
2/28/2022
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
869 Hillcrest Road #4025
Mobile, AL 36695
United States
County
Mobile
Phone
251-633-6235 (Phone)
Billing Details
Address
869 Hillcrest Road
#4025
Mobile, AL 36695
Billing Phone
251-633-6235
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address