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Contract Details
Champion Sports Medicine--Hueytown
Facility name
Provider ID
P000001253
NPI
1043234784
Tax ID
721379381
Effective Date
7/1/2005
Last Updated
6/4/2014
Direct Contract
Yes
Term Date
6/4/2014
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
3014 Allison Bonnett Memorial Drive Suites 144 & 146
Hueytown, AL 35023
United States
County
Jefferson
Phone
2057449444 (Phone)
Billing Details
Address
P.O. Box 1245
Indiana, PA 15701
Billing Phone
7244653496
Specialty Type
Physical Therapy
Map
Address