Thesselon    Monderson    MD
Contract Details
Vaughan Orthopedics
Facility name
Provider ID
P000009016
NPI
1689838286
Tax ID
205831435
Effective Date
11/13/2017
Last Updated
11/29/2017
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
1023 Medical Center Pkwy. Suite 301
Selma, AL 36701
United States
County
Dallas
Phone
3348773550 (Phone)
Billing Details
Address
P.O. Box 1206
Selma, AL 36702
Billing Phone
6153285245
Specialty Type
Surgery, Orthopedic
Map
Address