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Barton
S
Wood
MD
Contract Details
Jefferson-Shelby Surgical Associates
Facility name
Provider ID
P000008395
NPI
1477588309
Tax ID
630967549
Effective Date
2/17/2016
Last Updated
2/22/2016
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
636 2nd Street Northeast Suite A
Alabaster, AL 35007
United States
County
Shelby
Phone
2056631180
(
Phone
)
Billing Details
Address
P.O. Box 11407
DEPT #1755
Birmingham, AL 35246
Billing Phone
2056631180
Specialty Type
Surgery, General
Map
Address