Jennifer  L  Daigrepont    RPT
Contract Details
Champion Sports Medicine--Birmingham-Hoover
Facility name
Provider ID
P000006797
NPI
1316983653
Tax ID
721379381
Effective Date
3/21/2011
Last Updated
6/4/2014
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
3049 Highway 150 Suite 102
Birmingham, AL 35244
United States
County
Jefferson
Phone
2059888542 (Phone)
Billing Details
Address
P.O. Box 1245
Indiana, PA 15701
Billing Phone
7244653496
Specialty Type
Physical Therapy
Map
Address