Contract Details
Eastern Shore Neurology Clinic, Inc.
Facility name
Eastern Shore Neurology & Pain Center
Provider ID
P000002099
NPI
1306818869
Tax ID
721380230
Effective Date
3/15/2010
Last Updated
10/28/2016
Direct Contract
Yes
Term Date
10/28/2016
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
27535 Highway 98
Daphne, AL 36526
United States
County
Baldwin
Phone
2519713030 (Phone)
Billing Details
Address
27535 Highway 98
Daphne, AL 36526
Billing Phone
2519713030
Specialty Type
Neurology
Map
Address