Tara    Randalls    NP
Contract Details
Metro Infectious Disease Consultants
Facility name
Provider ID
P000000001
NPI
1235125717
Tax ID
363966745
Effective Date
6/3/2021
Last Updated
10/30/2023
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
F
Fee Schedule Name
107.00
Fee Schedule Multiplier
Location Details
Address
123 Ana Drive
Florence, AL 35630
United States
Phone
888-220-6432 (Phone)
Billing Details
Address
123 Ana Drive
Burr Ridge, IL 35630
Billing Phone
888-220-6432
Specialty Type
Infectious Diseases
Map
Address