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