James  D  Thacker    MD
Contract Details
Huntsville Pain Management
Facility name
Provider ID
P000008531
NPI
1962564476
Tax ID
454045858
Effective Date
12/15/2016
Last Updated
12/19/2016
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
89.00
Location Details
Address
185 Chateau Drive SW Suite 302
Huntsville, AL 35801
United States
County
Madison
Phone
2568851605 (Phone)
Billing Details
Address
185 Chateau Drive SW
Suite 302
Huntsville, AL 35801
Billing Phone
2568851605
Specialty Type
Pain Management
Map
Address