Ricky    Tubbs    MD
Contract Details
Gardendale Pain Management
Facility name
Provider ID
P000009066
NPI
1184800971
Tax ID
812840419
Effective Date
1/25/2018
Last Updated
1/29/2018
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
2215 Decatur Hwy Suite 101
Gardendale, AL 35071
United States
County
Jefferson
Phone
2056088199 (Phone)
Billing Details
Address
2215 Decatur Hwy
Suite 101
Gardendale, AL 35071
Billing Phone
2056088199
Specialty Type
Pain Management
Map
Address