Russell  L  Ellis    MD
Contract Details
Decatur Orthopaedic Clinic
Facility name
Provider ID
P000007751
NPI
1134292766
Tax ID
630799912
Effective Date
4/22/2014
Last Updated
10/29/2021
Direct Contract
Yes
Term Date
10/11/2021
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
90.00
Location Details
Address
1103 16th Avenue Southeast
Decatur, AL 35601
United States
County
Morgan
Phone
2563500362 (Phone)
Billing Details
Address
1103 16th Avenue Southeast
Decatur, AL 35601
Billing Phone
2563500362
Specialty Type
Physical Medicine & Rehabilitation
Map
Address