Max Louis    Pavlock    DO
Contract Details
Covington Family Care
Facility name
Provider ID
P000001321
Tax ID
631209008
Effective Date
7/15/2009
Last Updated
6/10/2014
Direct Contract
Yes
Term Date
11/20/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
508 East Three Notch Street
Andalusia, AL 36420
United States
County
Covington
Phone
3344272273 (Phone)
Billing Details
Address
P.O. Box 310
Andalusia, AL 36420
Billing Phone
3344272273
Specialty Type
General Practice
Map
Address