Dimo    Popov    MD
Contract Details
Russell Medical Center
Facility name
Provider ID
P000007375
NPI
1740289230
Tax ID
630385130
Effective Date
3/1/1999
Last Updated
6/10/2014
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
90.00
Location Details
Address
3368 Highway 280 Suite 220
Alexander City, AL 35010
United States
County
Tallapoosa
Phone
2564091500 (Phone)
Billing Details
Address
P.O. Box 939
Alexander City, AL 35011
Billing Phone
2563297109
Specialty Type
Nephrology
Map
Address