Timothy  M  Iliff    MD
Contract Details
IMC--Northside Clinic
Facility name
Provider ID
P000000820
NPI
1770564395
Tax ID
630861060
Effective Date
8/18/1992
Last Updated
4/9/2014
Direct Contract
Yes
Term Date
4/9/2014
Status
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
1020 Cleveland Road
Saraland, AL 36571
United States
County
Mobile
Phone
2516754733 (Phone)
Billing Details
Address
Specialty Type
General Practice
Map
Address