Allyson    Mobley    CRNP
Contract Details
PainSouth, Inc.
Facility name
Provider ID
P000009041
NPI
1982892196
Tax ID
631203826
Effective Date
1/5/2018
Last Updated
2/5/2019
Direct Contract
Yes
Term Date
2/5/2019
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
2700 10th Avenue South Suite 444
Birmingham, AL 35205
United States
County
Jefferson
Phone
2052979801 (Phone)
Billing Details
Address
2700 10th Avenue South
Suite 444
Birmingham, AL 35205
Billing Phone
2052979801
Specialty Type
Pain Management - Procedures Only
Map
Address