Vaughn  H  Mancha    MD
Contract Details
American Family Care--Montgomery-Governor's House
Facility name
Provider ID
P000003579
NPI
1184738668
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
2936 Marti Lane
Montgomery, AL 36116
United States
County
Montgomery
Phone
3342880088 (Phone)
Billing Details
Address
P.O. Box 830810
Birmingham, AL 35283
Billing Phone
2054038902
Specialty Type
Family Practice
Map
Address