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Contract Details
Southeast Alabama Medical Center Clinics
Facility name
Enterprise Medical Clinic
Provider ID
P000002384
NPI
1619026606
Tax ID
636004476
Effective Date
7/1/1995
Last Updated
8/6/2014
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
101 Professional Lane
Enterprise, AL 36330
United States
County
Coffee
Phone
3343473404
(
Phone
)
Billing Details
Address
101 Professional Lane
Enterprise, AL 36330
Billing Phone
3343473404
Specialty Type
Family Practice
Map
Address