Contract Details
Facility name
The Orthopaedic Group
Provider ID
P000002461
NPI
1164489951
Tax ID
631187140
Effective Date
6/15/1999
Last Updated
9/3/2015
Direct Contract
Yes
Term Date
6/25/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
90.00
Location Details
Address
1301 Belleville Avenue
Brewton, AL 36427
United States
County
Escambia
Phone
2514765050 (Phone)
Billing Details
Address
P.O. Box 86144
Mobile, AL 36689
Billing Phone
2514765050
Specialty Type
Surgery, Orthopedic
Map
Address