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Contract Details
PriMed--Montgomery-Atlanta Highway
Facility name
Provider ID
P000001699
NPI
1356455497
Tax ID
200436418
Effective Date
4/18/1995
Last Updated
7/22/2014
Direct Contract
Yes
Term Date
12/4/2013
Status
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
4305 Atlanta Highway
Montgomery, AL 36109
United States
County
Montgomery
Phone
3342717051 (Phone)
Billing Details
Address
100 Capitol Commerce Boulevard
Suite 250
Montgomery, AL 36117
Billing Phone
3343234000
Specialty Type
Internal Medicine
Map
Address