Contract Details
Facility name
Southern Family Practice & Occupational Medicine
Provider ID
P000002421
NPI
1326077108
Tax ID
631069571
Effective Date
2/15/2010
Last Updated
6/10/2014
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
700 Quintard Avenue
Anniston, AL 36202
United States
County
Calhoun
Phone
2562369400 (Phone)
Billing Details
Address
P.O. Box 457
Anniston, AL 36202
Billing Phone
2562369400
Specialty Type
Family Practice
Map
Address