Jon  W  Davis    RPT
Contract Details
Champion Sports Medicine--Huntsville
Facility name
Provider ID
P000006801
NPI
1427145333
Tax ID
721379381
Effective Date
8/16/2010
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
5107 Moores Mill Road Suite C
Huntsville, AL 35811
United States
County
Madison
Phone
2568524622 (Phone)
Billing Details
Address
P.O. Box 1245
Indiana, PA 15701
Billing Phone
7244653496
Specialty Type
Physical Therapy
Map
Address