Jason    West    MD
Contract Details
Northside Clinic
Facility name
Provider ID
P000008243
NPI
1053513135
Tax ID
631012832
Effective Date
10/7/2022
Last Updated
10/31/2022
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
95 Shell Street
Saraland, AL 36571
United States
County
Mobile
Phone
2516754733 (Phone)
Billing Details
Address
95 Shell Street
Saraland, AL 36571
Billing Phone
2516754733
Specialty Type
Family Practice
Map
Address