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Samantha
H
Simmons
NP
Contract Details
Eastern Shore Urgent Care
Facility name
Provider ID
P000003471
NPI
1609140540
Tax ID
260765701
Effective Date
5/15/2010
Last Updated
1/5/2016
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
29710 Urgent Care Drive
Daphne, AL 36526
United States
County
Baldwin
Phone
2516263782
(
Phone
)
Billing Details
Address
P.O. Box 4152
Belfast, ME 04915
Billing Phone
8007000278
Specialty Type
Family Practice
Map
Address