Perry    Lovely    MD
Contract Details
MedCenter South
Facility name
Provider ID
P000007489
NPI
1679588255
Tax ID
631274310
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
5005 Oscar Baxter Drive
Tuscaloosa, AL 35405
United States
County
Tuscaloosa
Phone
2053432225 (Phone)
Billing Details
Address
5005 Oscar Baxter Drive
Tuscaloosa, AL 35405
Billing Phone
2053432225
Specialty Type
Emergency Medicine
Map
Address