Contract Details
Facility name
Southern Orthopedic & Sports Medicine Associates
Provider ID
P000002429
NPI
1184647323
Tax ID
630889081
Effective Date
2/1/1999
Last Updated
5/21/2017
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
90.00
Location Details
Address
2950 Highway 78 East
Jasper, AL 35501
United States
County
Walker
Phone
2052215374 (Phone)
Billing Details
Address
P.O. Box 580
Jasper, AL 35502
Billing Phone
2052215374
Specialty Type
Surgery, Orthopedic
Map
Address