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Bruce
R
Williams
MD
Contract Details
Elba Family Medicine
Facility name
Provider ID
P000007712
NPI
1417907791
Tax ID
271826294
Effective Date
2/1/2014
Last Updated
6/1/2015
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
F
Fee Schedule Name
106.00
Fee Schedule Multiplier
Location Details
Address
918 Drayton Avenue
Elba, AL 36323
United States
County
Coffee
Phone
3348530191
(
Phone
)
Billing Details
Address
P.O. Box 9395
Belfast, ME 04915
Billing Phone
3348530191
Specialty Type
Internal Medicine
Map
Address