Sam  W  Chen    RPT
Contract Details
Champion Sports Medicine--Tuscaloosa-University of Alabama
Facility name
Provider ID
P000006800
NPI
1861772626
Tax ID
721379381
Effective Date
9/1/2011
Last Updated
6/4/2014
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
401 5th Avenue East
Tuscaloosa, AL 35487
United States
County
Tuscaloosa
Phone
2053483904 (Phone)
Billing Details
Address
P.O. Box 1245
Indiana, PA 15701
Billing Phone
7244653496
Specialty Type
Physical Therapy
Map
Address