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Clayton
G
Lane
MD
Contract Details
Alabama Orthopaedic Clinic
Facility name
Provider ID
P000000959
NPI
1407078884
Tax ID
631174582
Effective Date
6/26/2018
Last Updated
8/4/2021
Direct Contract
Yes
Term Date
8/3/2021
Status
Active
W9 Attachment
Contract Discounts
Discount Type
M
Exhibit ID
AM_388
AM_388
Location Details
Address
1720 Springhill Avenue Suite 301
Mobile, AL 36604
United States
County
Mobile
Phone
2514103600
(
Phone
)
Billing Details
Address
1720 Springhill Avenue
Suite 301
Mobile, AL 36604
Billing Phone
2514103600
Specialty Type
Surgery, Orthopedic
Map
Address