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Contract Details
One Call Care Management
Facility name
Shades Mountain Imaging
Provider ID
P000002405
NPI
1033157185
Tax ID
223218521
Effective Date
6/1/1999
Last Updated
10/13/2015
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
M
Exhibit ID
AM_059
AM_059
Location Details
Address
502 Montgomery Highway Suite 101
Birmingham, AL 35216
United States
County
Jefferson
Phone
2058230882
(
Phone
)
Billing Details
Address
P.O. Box 614
Parsippany, NJ 07054
Billing Phone
8008722875
Specialty Type
Diagnostic Services
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Address