James    Taylor    DPM
Contract Details
Facility name
Provider ID
P000004119
NPI
1245563501
Tax ID
264252436
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
4600 Memorial Dr Suite 80
Belleville, IL 62226
United States
County
Saint Clair
Phone
6182770001 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Podiatry
Map
Address