N. Tucker    Mattox  Jr  MD
Contract Details
Southern Orthopaedic Surgeons
Facility name
Provider ID
P000001077
NPI
1750341913
Tax ID
631178354
Effective Date
11/6/2000
Last Updated
6/9/2016
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
488 St. Lukes Drive
Montgomery, AL 36117
United States
County
Montgomery
Phone
3346139000 (Phone)
Billing Details
Address
488 St. Lukes Drive
Montgomery, AL 36117
Billing Phone
3346139000
Specialty Type
Surgery, Orthopedic
Map
Address