Perry    Lovely    MD
Contract Details
MedCenter North
Facility name
Provider ID
P000007489
NPI
1679588255
Tax ID
203844912
Effective Date
12/1/2006
Last Updated
11/16/2017
Direct Contract
Yes
Term Date
11/13/2017
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
3909 McFarland Boulevard
Northport, AL 35476
United States
County
Tuscaloosa
Phone
2053331993 (Phone)
Billing Details
Address
3909 McFarland Boulevard
Northport, AL 35476
Billing Phone
2053331993
Specialty Type
Emergency Medicine
Map
Address