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John
Campbell
DO
Contract Details
Hartford Family Care
Facility name
Provider ID
P000008199
NPI
1669453767
Tax ID
271826294
Effective Date
2/1/2014
Last Updated
7/27/2020
Direct Contract
Yes
Term Date
7/27/2020
Status
W9 Attachment
Contract Discounts
Discount Type
F
Fee Schedule Name
106.00
Fee Schedule Multiplier
Location Details
Address
169 North 2nd Avenue
Hartford, AL 36344
United States
County
Geneva
Phone
3343488818
(
Phone
)
Billing Details
Address
169 North 2nd Avenue
Belfast, ME 36344
Billing Phone
3343488818
Specialty Type
Internal Medicine
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Address