Mark  B  Ellis    DO
Contract Details
Primecare of Dothan
Facility name
Provider ID
P000000491
NPI
1083632244
Tax ID
260789394
Effective Date
11/15/2001
Last Updated
12/19/2017
Direct Contract
Yes
Term Date
9/30/2017
Status
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
4126 West Main Street
Dothan, AL 36305
United States
County
Houston
Phone
3347932120 (Phone)
Billing Details
Address
4126 West Main Street
Dothan, AL 36305
Billing Phone
3347932120
Specialty Type
Family Practice
Map
Address