Kimberly    Becker    RPT
Contract Details
Champion Sports Medicine--Gardendale
Facility name
Provider ID
P000000108
NPI
1194845529
Tax ID
721379381
Effective Date
6/1/1999
Last Updated
2/19/2018
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
592 Fieldstown Road Suite 114 & 116
Gardendale, AL 35071
United States
County
Jefferson
Phone
2056083606 (Phone)
Billing Details
Address
P.O. Box 1245
Indiana, PA 15701
Billing Phone
7244653496
Specialty Type
Physical Therapy
Map
Address