Maria  G  Rabin-Go    MD
Contract Details
Medical Asset Group
Facility name
Provider ID
P000001412
NPI
1316045586
Tax ID
631105532
Effective Date
4/18/2023
Last Updated
4/19/2023
Direct Contract
Yes
Term Date
4/18/2023
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
15239 Highway 68 West
Crossville, AL 35962
United States
County
De Kalb
Phone
256-907-9000 (Phone)
Billing Details
Address
15239 Highway 68 West
Crossville, AL 35962
Billing Phone
256-907-9000
Specialty Type
Internal Medicine
Map
Address