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Contract Details
Facility name
Nutritional Parenteral Home Care
Provider ID
P000002285
NPI
1073681706
Tax ID
631284325
Effective Date
7/8/2009
Last Updated
9/3/2015
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
500 Paul Bryant Drive East Suite B
Tuscaloosa, AL 35401
United States
County
Tuscaloosa
Phone
2053454566
(
Phone
)
Billing Details
Address
P.O. Box 534411
Atlanta, GA 30353
Billing Phone
2053454566
Specialty Type
Home Infusion
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