Jeffrey  R  Cusmariu    MD
Contract Details
OrthoSports Associates--Gardendale
Facility name
Provider ID
P000000378
NPI
1104894021
Tax ID
275501752
Effective Date
5/16/2012
Last Updated
3/3/2017
Direct Contract
Yes
Term Date
2/28/2017
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
2217 Decatur Highway
Gardendale, AL 35071
United States
County
Jefferson
Phone
2054181260 (Phone)
Billing Details
Address
2217 Decatur Highway
Gardendale, AL 35071
Billing Phone
2054181260
Specialty Type
Surgery, Orthopedic
Map
Address