Amy  L  Illescas    MD
Contract Details
American Family Care--Fairfield-Flintridge
Facility name
Provider ID
P000000821
NPI
1346269123
Tax ID
630825248
Effective Date
7/1/2011
Last Updated
5/27/2014
Direct Contract
Yes
Term Date
9/11/2011
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
6554 Aaron Aronov Drive
Fairfield, AL 35064
United States
County
Jefferson
Phone
2057865022 (Phone)
Billing Details
Address
P.O. Box 830810
Birmingham, AL 35283
Billing Phone
2054038902
Specialty Type
Internal Medicine
Map
Address