Contract Details
Facility name
Southeastern Pain Management
Provider ID
P000002417
NPI
1902974561
Tax ID
721398641
Effective Date
12/1/2006
Last Updated
8/19/2014
Direct Contract
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
1026 Goodyear Avenue Suite 302
Gadsden, AL 35903
United States
County
Etowah
Phone
2564927246 (Phone)
Billing Details
Address
1026 Goodyear Avenue
Suite 302
Gadsden, AL 35903
Billing Phone
Specialty Type
Pain Management Facility
Map
Address