Carlos    Ganuza    MD
Contract Details
Northeast Orthopedic Clinic, PC
Facility name
Provider ID
P000000591
NPI
1598711079
Tax ID
631081989
Effective Date
10/15/1999
Last Updated
9/2/2016
Direct Contract
Yes
Term Date
10/16/1999
Status
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
507 South 4th Street
Gadsden, AL 35901
United States
County
Etowah
Phone
2565477417 (Phone)
Billing Details
Address
507 South 4th Street
Gadsden, AL 35901
Billing Phone
2565477417
Specialty Type
Rheumatology
Map
Address