Jack    Vibbert    MD
Contract Details
Northside Medical Associates
Facility name
Provider ID
P000000001
NPI
1063924868
Tax ID
813943463
Effective Date
8/31/2020
Last Updated
6/17/2022
Direct Contract
Yes
Term Date
6/17/2022
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
7201 Happy Hollow Road
Trussville, AL 35173
United States
Phone
205-358-4017 (Phone)
Billing Details
Address
7201 Happy Hollow Road
Trussville, AL 35173
Billing Phone
205-358-4017
Specialty Type
Family Practice
Map
Address