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Contract Details
Facility name
Southern Bone & Joint Specialists
Provider ID
P000002419
NPI
1083898852
Tax ID
200870135
Effective Date
7/1/1998
Last Updated
6/9/2016
Direct Contract
Yes
Term Date
8/28/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
90.00
Location Details
Address
4300 West Main Street Suite 14
Dothan, AL 36301
United States
County
Houston
Phone
3347932663
(
Phone
)
Billing Details
Address
P.O. Box 729
Dothan, AL 36302
Specialty Type
Surgery, Orthopedic
Map
Address