Contract Details
The Russell Hospital Corporation
Facility name
Medical Park Family Care
Provider ID
P000002252
NPI
1215953799
Tax ID
630385130
Effective Date
2/21/2001
Last Updated
6/10/2014
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
1034 South Tallassee Street
Dadeville, AL 36853
United States
County
Tallapoosa
Phone
2568259900 (Phone)
Billing Details
Address
P.O. Box 589
Dadeville, AL 36853
Billing Phone
2568259900
Specialty Type
Family Practice
Map
Address