Jill    Elmore    CRNP
Contract Details
Andalusia Family Care
Facility name
Provider ID
P000009274
NPI
1285841270
Tax ID
208016585
Effective Date
12/5/2018
Last Updated
12/19/2018
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
95.00
Location Details
Address
301 Medical Avenue Suite A
Andalusia, AL 36420
United States
County
Covington
Phone
3342221366 (Phone)
Billing Details
Address
P.O. Box 1720
Andalusia, AL 36420
Billing Phone
3342221366
Specialty Type
Internal Medicine
Map
Address