Phillip  A  Triantos    MD
Contract Details
Shades Mountain Imaging
Facility name
Provider ID
P000007285
NPI
1104821297
Tax ID
201202415
Effective Date
3/1/2007
Last Updated
12/30/2013
Direct Contract
Yes
Term Date
12/30/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
502 Montgomery Highway Suite 101
Birmingham, AL 35216
United States
County
Jefferson
Phone
2058230882 (Phone)
Billing Details
Address
502 Montgomery Highway
Suite 101
Birmingham, AL 35216
Billing Phone
2058230882
Specialty Type
Radiology, Diagnostic
Map
Address