Robert  E  Vickers    MD
Contract Details
Greater Mobile Urgent Care--Citronelle
Facility name
Provider ID
P000007758
NPI
1982611158
Tax ID
273176829
Effective Date
5/1/2014
Last Updated
5/13/2014
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
19355 North 3rd Street Suite 104
Citronelle, AL 36522
United States
County
Mobile
Phone
2516330123 (Phone)
Billing Details
Address
7943 Moffett Road
Semmes, AL 36575
Billing Phone
2516330123
Specialty Type
Emergency Medicine
Map
Address