Mark  A  Prevost    MD
Contract Details
Southern Orthopedic and Sports Medicine Associates
Facility name
Provider ID
P000001397
NPI
1720086861
Tax ID
630889081
Effective Date
2/1/1999
Last Updated
6/10/2016
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
90.00
Location Details
Address
3400 Highway 78 East
Jasper, AL 35501
United States
County
Walker
Phone
2052215374 (Phone)
Billing Details
Address
P.O. Box 580
Jasper, AL 35502
Specialty Type
Surgery, Orthopedic
Map
Address