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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
W9 Attachment
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
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Address