Mariely    Castellanos Nouel    MD
Contract Details
BHC Talladega
Facility name
Provider ID
P000000272
NPI
1649506494
Tax ID
631051664
Effective Date
1/1/1996
Last Updated
2/9/2015
Direct Contract
Yes
Term Date
2/9/2015
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
320 East Coosa Street
Talladega, AL 35160
United States
County
Talladega
Phone
2563624000 (Phone)
Billing Details
Address
P.O. Box 830605
Birmingham, AL 35283
Billing Phone
2563624000
Specialty Type
Internal Medicine
Map
Address