Amy  B  Sanders    RPT
Contract Details
Champion Sports Medicine--Jasper
Facility name
Provider ID
P000001543
NPI
1841254836
Tax ID
721379381
Effective Date
3/1/1999
Last Updated
10/17/2022
Direct Contract
Yes
Term Date
9/9/2022
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
1705 Highway 78 East Suite 500
Jasper, AL 35501
United States
County
Walker
Phone
2053020140 (Phone)
Billing Details
Address
1705 Highway 78 East
Suite 500
Indiana, PA 35501
Billing Phone
7244653496
Specialty Type
Physical Therapy
Map
Address