Jennifer  L  Spann    RPT
Contract Details
Champion Sports Medicine--Calera
Facility name
Provider ID
P000006803
NPI
1144477670
Tax ID
721379381
Effective Date
12/1/2011
Last Updated
3/7/2017
Direct Contract
Yes
Term Date
11/30/2016
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
71 Limestone Parkway Suite B
Calera, AL 35040
United States
County
Shelby
Phone
2056681967 (Phone)
Billing Details
Address
P.O. Box 1245
Indiana, PA 15701
Billing Phone
7244653496
Specialty Type
Physical Therapy
Map
Address