Robert    Russell    MD
Contract Details
South Baldwin Medical Center - Gulf Shores Urgent Care
Facility name
Provider ID
P000008687
NPI
1710935663
Tax ID
621822362
Effective Date
4/3/2017
Last Updated
4/19/2017
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
83.00
Location Details
Address
101 E 15th Ave
Gulf Shores, AL 36542
United States
County
Baldwin
Phone
2519621250 (Phone)
Billing Details
Address
1613 N McKenzie St
Foley, AL 36535
Billing Phone
2519621250
Specialty Type
Emergency Medicine
Map
Address