Ernest Van    Johnson    MD
Contract Details
Tuscaloosa Ophthalmology
Facility name
Provider ID
P000000843
NPI
1477578110
Tax ID
631074848
Effective Date
3/1/1999
Last Updated
5/5/2014
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
535 Jack Warner Parkway Northeast Suite B-1
Tuscaloosa, AL 35404
United States
County
Tuscaloosa
Phone
2055562121 (Phone)
Billing Details
Address
535 Jack Warner Parkway Northeast
Suite B-1
Tuscaloosa, AL 35404
Billing Phone
2055562121
Specialty Type
Ophthalmology
Map
Address