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A. Chandler
Muller
DO
Contract Details
AllSouth Urgent Care Clinic Inc.
Facility name
Provider ID
P000007961
NPI
1114940129
Tax ID
263314700
Effective Date
1/30/2017
Last Updated
2/16/2017
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
1052 Ross Clark Circle
Dothan, AL 36303
United States
County
Houston
Phone
3346993600
(
Phone
)
Billing Details
Address
1052 Ross Clark Circle
Dothan, AL 36303
Billing Phone
3346993600
Specialty Type
Internal Medicine
Map
Address