Contract Details
Facility name
Southern Orthopaedic Surgeons, LLC
Provider ID
P000002428
NPI
1356563613
Tax ID
631178354
Effective Date
11/6/2000
Last Updated
5/21/2017
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
668 McQueen Smith Road North
Prattville, AL 36066
United States
County
Autauga
Phone
3346139000 (Phone)
Billing Details
Address
P.O. Box 250450
Montgomery, AL 36125
Billing Phone
3346139000
Specialty Type
Surgery, Orthopedic
Map
Address