Theodore  D  Baker    MD
Contract Details
Cullman Open MRI
Facility name
Provider ID
P000007663
NPI
1508861287
Tax ID
630587021
Effective Date
11/5/2013
Last Updated
5/10/2017
Direct Contract
Yes
Term Date
5/8/2017
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
1809 Dahlke Drive
Cullman, AL 35058
United States
County
Cullman
Phone
2562556737 (Phone)
Billing Details
Address
P.O. Box 2514
Birmingham, AL 35201
Billing Phone
2058714274
Specialty Type
Radiology, Diagnostic
Map
Address