Contract Details
Facility name
Southlake Orthopaedics Sports Medicine and Spine Center
Provider ID
P000002433
NPI
1518970722
Tax ID
721353855
Effective Date
1/1/2006
Last Updated
5/21/2017
Direct Contract
Yes
Term Date
8/26/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
513 Brookwood Boulevard Suite 402
Birmingham, AL 35209
United States
County
Jefferson
Phone
2058026898 (Phone)
Billing Details
Address
P.O. Box 830791
Birmingham, AL 35283
Billing Phone
2059854111
Specialty Type
Surgery, Orthopedic
Map
Address