Jerry  W  Bush    MD
Contract Details
PriMed--Prattville
Facility name
Provider ID
P000000236
NPI
1952424848
Tax ID
200436418
Effective Date
8/1/1998
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
1595 East Main Street
Prattville, AL 36066
United States
County
Autauga
Phone
3343613171 (Phone)
Billing Details
Address
100 Capitol Commerce Boulevard
Suite 250
Montgomery, AL 36117
Billing Phone
3343234000
Specialty Type
Internal Medicine
Map
Address