Address: 6701 Airport Blvd. D100, Mobile, 36608, United States
Telephone: 251-607-6117

Bendt Petersen III MD

Contract Details

Petersen Neurospine

Facility name

Provider ID

P000000001

NPI

1477510915

Tax ID

205318205

Effective Date

7/22/2020

Last Updated

7/23/2020

Direct Contract

Yes

Status

Active

Contract Discounts

Discount Type

State Fee Schedule Multiplier

90.00

Location Details

Address

6701 Airport Blvd. D100

Mobile, AL 36608

United States

Phone

251-607-6117 (Phone)

Fax

Billing Details

Address

6701 Airport Blvd.

D100

Mobile, AL 36608

Billing Phone

Specialty Type

Surgery, Orthopedic

Workers Comp Coordinator

Joy

Richardson

251-341-077

jrich@petersenneurospine.net

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