Andrew  R  McNally    RPT
Contract Details
Champion Sports Medicine--Troy
Facility name
Provider ID
P000006798
NPI
1770834210
Tax ID
721379381
Effective Date
9/17/2012
Last Updated
2/8/2019
Direct Contract
Yes
Term Date
10/31/2018
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
3226 Veterans Stadium Drive
Troy, AL 36082
United States
County
Pike
Phone
3346705955 (Phone)
Billing Details
Address
P.O. Box 1245
Indiana, PA 15701
Billing Phone
7244653496
Specialty Type
Physical Therapy
Map
Address