David  W  Purner    MD
Contract Details
American Family Care--Hampton Cove
Facility name
Provider ID
P000003501
NPI
1083623987
Tax ID
630825248
Effective Date
7/1/2011
Last Updated
5/27/2014
Direct Contract
Yes
Term Date
5/27/2014
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
410 Sutton Road Southeast
Owens Cross Roads, AL 35763
United States
County
Madison
Phone
2564244260 (Phone)
Billing Details
Address
P.O. Box 830810
Birmingham, AL 35283
Billing Phone
2054038902
Specialty Type
General Practice
Map
Address