Richard  E  Grant    MD
Contract Details
Etowah Pain Associates
Facility name
Provider ID
P000008527
NPI
1790942571
Tax ID
464781772
Effective Date
12/15/2016
Last Updated
12/19/2016
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
83.00
Location Details
Address
3015 Steele Station Road
Rainbow City, AL 35906
United States
County
Etowah
Phone
2564565811 (Phone)
Billing Details
Address
P.O. Box 18682
Huntsville, AL 35804
Billing Phone
2566531487
Specialty Type
Pain Management
Map
Address