Contract Details
Southern Bone & Joint Sports Medicine & Rehab
Facility name
Southern Bone & Joint Specialists
Provider ID
P000002418
NPI
1134106065
Tax ID
200870135
Effective Date
10/4/1999
Last Updated
5/21/2017
Direct Contract
Yes
Term Date
8/28/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
1500 Ross Clark Circle
Dothan, AL 36301
United States
County
Houston
Phone
3347932663 (Phone)
Billing Details
Address
P.O. Box 729
Dothan, AL 36302
Specialty Type
Physical Medicine & Rehabilitation
Map
Address