Mark  A  Goddard    MD
Contract Details
Medica Stand-Up MRI of Birmingham
Facility name
Provider ID
P000000623
NPI
1487606323
Tax ID
201057126
Effective Date
3/1/2005
Last Updated
8/29/2014
Direct Contract
Yes
Term Date
6/7/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
3105 Independence Drive Suite 101
Birmingham, AL 35209
United States
County
Jefferson
Phone
2058713335 (Phone)
Billing Details
Address
P.O. Box 2901
Kennesaw, GA 30156
Billing Phone
2058713335
Specialty Type
Radiology, Diagnostic
Map
Address