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Contract Details
Facility name
Southern Bone & Joint Specialists
Provider ID
P000002420
NPI
1447628060
Tax ID
200870135
Effective Date
8/4/2000
Last Updated
5/21/2017
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
90.00
Location Details
Address
404 North Main Street
Enterprise, AL 36330
United States
County
Coffee
Phone
3343089797
(
Phone
)
Billing Details
Address
P.O. Box 729
Dothan, AL 36302
Billing Phone
3347932663
Specialty Type
Surgery, Orthopedic
Map
Address