Raynard    Fabianke    MD
Contract Details
Medical Clinic of Red Bay
Facility name
Provider ID
P000000001
NPI
1851387575
Tax ID
631069774
Effective Date
9/23/2020
Last Updated
10/6/2020
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
209 Hospital Road
Red Bay, AL 35582
United States
Phone
256-356-9511 (Phone)
Billing Details
Address
209 Hospital Road
Red Bay, AL 35582
Billing Phone
256-356-9511
Specialty Type
Family Practice
Map
Address