Shivani    Malhotra    MD
Contract Details
Crestwood Workers Care
Facility name
Provider ID
P000007377
NPI
1336378801
Tax ID
273920921
Effective Date
10/25/2011
Last Updated
5/25/2016
Direct Contract
Yes
Term Date
5/18/2016
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
90.00
Location Details
Address
4810 Whitesport Circle Suite 215
Huntsville, AL 35801
United States
County
Madison
Phone
2564294540 (Phone)
Billing Details
Address
4810 Whitesport Circle
Suite 215
Huntsville, AL 35801
Billing Phone
2564294540
Specialty Type
Family Practice
Map
Address