Amy    Stanley    NP
Contract Details
Bayside Orthopedic & Rehabilitation Center
Facility name
Provider ID
P000000001
NPI
1972250652
Tax ID
630730089
Effective Date
6/1/2022
Last Updated
6/8/2022
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
M
Exhibit ID
AM_158
Location Details
Address
341 North Greeno Road
Fairhope, AL 36532
United States
Phone
251-928-2401 (Phone)
Billing Details
Address
P.O. Box 1186
Fairhope, AL 36532
Billing Phone
251-928-2401
Specialty Type
Nurse Practitioner
Map
Address