Jesse    Connor    LMT
Contract Details
ColeidoScopes
Facility name
Provider ID
P000008692
NPI
1932369774
Tax ID
473095231
Effective Date
5/2/2017
Last Updated
3/4/2022
Direct Contract
Yes
Term Date
2/28/2022
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
70.00
Location Details
Address
15 Office Park Circle Suite 150
Mountain Brook, AL 35223
United States
County
Jefferson
Phone
2054965667 (Phone)
Billing Details
Address
15 Office Park Circle
Suite 150
Mountain Brook, AL 35223
Billing Phone
2054965667
Specialty Type
Massage Therapist
Map
Address