Candice  M  Keene    RPT
Contract Details
Champion Sports Medicine--Livingston
Facility name
Provider ID
P000006791
NPI
1912226119
Tax ID
721379381
Effective Date
3/12/2012
Last Updated
6/5/2014
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
1 College Drive
Livingston, AL 35470
United States
County
Sumter
Phone
2056523714 (Phone)
Billing Details
Address
P.O. Box 1245
Indiana, PA 15701
Billing Phone
7244653496
Specialty Type
Physical Therapy
Map
Address