Javier    Reto    MD
Contract Details
SportsMed Orthopaedic & Spine Center
Facility name
Provider ID
P000008469
NPI
1073707816
Tax ID
631262177
Effective Date
8/1/2016
Last Updated
10/24/2016
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
M
Exhibit ID
AM_285
Location Details
Address
22423 Hwy 72 E Suite A
Athens, AL 35613
United States
County
Limestone
Phone
2562309607 (Phone)
Billing Details
Address
4715 Whitesburg Drive
Huntsville, AL 35802
Billing Phone
2568815151
Specialty Type
Surgery, Orthopedic Spine
Map
Address