Jack  W  Moore    MD
Contract Details
SportsMed Orthopaedic Surgery & Spine Center
Facility name
Provider ID
P000001188
NPI
1235170812
Tax ID
631262177
Effective Date
10/5/2000
Last Updated
5/20/2013
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
M
Exhibit ID
AM_001
Location Details
Address
22423 Highway 72 East Suite A
Athens, AL 35611
United States
County
Limestone
Phone
2562309607 (Phone)
Billing Details
Address
PO Box 999
Athens, AL 35612
Specialty Type
Surgery, Orthopedic
Map
Address