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Rodney
C
Perry
DO
Contract Details
Rainbow City Immediate Care
Facility name
Provider ID
P000001347
Tax ID
630959986
Effective Date
9/1/1998
Last Updated
7/23/2013
Direct Contract
Yes
Term Date
7/23/2013
Status
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
90.00
Location Details
Address
3326 Rainbow Drive
Rainbow City, AL 35906
United States
County
Etowah
Phone
2564421118
(
Phone
)
Billing Details
Address
Specialty Type
General Practice
Map
Address