Taylor    Countiss    PA-C
Contract Details
OrthoSports Associates
Facility name
Provider ID
P000009100
NPI
1851899322
Tax ID
275501752
Effective Date
12/13/2022
Last Updated
1/12/2023
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
M
Exhibit ID
AM_508
Location Details
Address
833 Saint Vincent's Drive Suite 403
Birmingham, AL 35205
United States
County
Jefferson
Phone
2059390447 (Phone)
Billing Details
Address
833 Saint Vincent's Drive
Suite 403
Birmingham, AL 35205
Billing Phone
2059390447
Specialty Type
Surgery, Orthopedic
Map
Address