John Andrew    Harcourt    MD
Contract Details
Baldwin Bone & Joint--Daphne
Facility name
Provider ID
P000000710
NPI
1104917764
Tax ID
631283588
Effective Date
10/1/2001
Last Updated
8/1/2018
Direct Contract
Yes
Term Date
7/29/2018
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
90.00
Location Details
Address
1505 Daphne Avenue
Daphne, AL 36526
United States
County
Baldwin
Phone
2516252663 (Phone)
Billing Details
Address
1505 Daphne Avenue
Daphne, AL 36526
Billing Phone
2516252663
Specialty Type
Sports Medicine
Map
Address