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Troy
H
Middleton
III
MD
Contract Details
Coastal Neurological Instritute
Facility name
Provider ID
P000001155
NPI
1831190024
Tax ID
630782200
Effective Date
2/6/2019
Last Updated
2/7/2019
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
M
Exhibit ID
AM_408
AM_408
Location Details
Address
3280 Dauphin Street Building A
Mobile, AL 36606
United States
County
Mobile
Phone
2514503700
(
Phone
)
Billing Details
Address
3280 Dauphin Street
Building A
Mobile, AL 36606
Billing Phone
2514503700
Specialty Type
Surgery, Neurological
Map
Address