Contract Details
Facility name
Southern Bone & Joint Specialists
Provider ID
P000002419
NPI
1083898852
Tax ID
200870135
Effective Date
10/4/1999
Last Updated
8/28/2013
Direct Contract
Yes
Term Date
8/28/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
4300 West Main Street Suite 14
Dothan, AL 36301
United States
County
Houston
Phone
3347932663 (Phone)
Billing Details
Address
PO Box 729
Dothan, AL 363020729
Specialty Type
Physical Medicine & Rehabilitation
Map
Address