Contract Details
Providence Healthcare Services, Inc.
Facility name
Mobile Diagnostic Center at Providence Park
Provider ID
P000002264
NPI
1386848356
Tax ID
631235666
Effective Date
2/1/2002
Last Updated
9/3/2015
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
6701 Airport Boulevard Suite A-101
Mobile, AL 36608
United States
County
Mobile
Phone
2516338880 (Phone)
Billing Details
Address
6701 Airport Boulevard
Suite A-101
Mobile, AL 36608
Billing Phone
2513423949
Specialty Type
General Practice
Map
Address