Charles Michael    Mead    MD
Contract Details
Shades Mountain Imaging
Facility name
Provider ID
P000001130
NPI
1205833761
Tax ID
201202415
Effective Date
3/1/2007
Last Updated
6/10/2016
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
502 Montgomery Highway Suite 101
Birmingham, AL 35216
United States
County
Jefferson
Phone
2058230882 (Phone)
Billing Details
Address
P.O. Box 11407
Birmingham, AL 35246
Specialty Type
Radiology, Diagnostic
Map
Address