Contract Details
Facility name
Southlake Orthopaedics Sports Medicine and Spine Center
Provider ID
P000002432
NPI
1043268402
Tax ID
721353855
Effective Date
1/1/2006
Last Updated
12/5/2019
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
4517 Southlake Parkway
Birmingham, AL 35244
United States
County
Jefferson
Phone
2055909756 (Phone)
Billing Details
Address
P.O. Box 830791
Birmingham, AL 35283
Billing Phone
2059854111
Specialty Type
Surgery, Orthopedic
Map
Address