Mark    Wilson    RPT
Contract Details
Champion Sports Medicine--Birmingham-St. Vincent's
Facility name
Provider ID
P000001886
NPI
1669491312
Tax ID
721379381
Effective Date
7/1/2005
Last Updated
1/26/2022
Direct Contract
Yes
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
805 Saint Vincent's Drive Suite G-100
Birmingham, AL 35205
United States
County
Jefferson
Phone
2059391557 (Phone)
Billing Details
Address
805 Saint Vincent's Drive
Suite G-100
Indiana, PA 35205
Billing Phone
7244653496
Specialty Type
Physical Therapy
Map
Address