Julio    Delgado    MD
Contract Details
All Med--Montgomery-Chantilly Corners
Facility name
Provider ID
P000007955
NPI
1780693051
Tax ID
200436418
Effective Date
4/18/1995
Last Updated
3/2/2016
Direct Contract
Yes
Term Date
3/2/2016
Status
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
9188 Eastchase Parkway
Montgomery, AL 36117
United States
County
Montgomery
Phone
3343234000 (Phone)
Billing Details
Address
100 Capitol Commerce Boulevard
Suite 250
Montgomery, AL 36117
Billing Phone
3343234000
Specialty Type
Family Practice
Map
Address