Michael  T  Ellerbusch    MD
Contract Details
Southlake Orthopaedics
Facility name
Provider ID
P000000001
NPI
1437107984
Tax ID
922164113
Effective Date
1/1/2024
Last Updated
1/8/2024
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
3686 Grandview Parkway Suite 430
Birmingham, AL 35243
United States
County
Jefferson
Phone
205-972-8785 (Phone)
Billing Details
Address
3686 Grandview Parkway
Suite 430
Birmingham, AL 35243
Billing Phone
205-972-8785
Specialty Type
Surgery, Orthopedic
Map
Address