Ginna    Prutzman    PA-C
Contract Details
Hughston Clinic
Facility name
Provider ID
P000000001
NPI
1184210114
Tax ID
581155460
Effective Date
6/1/2022
Last Updated
6/9/2022
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
4294 Lomac Street
Montgomery, AL 36106
United States
Phone
334-274-9000 (Phone)
Billing Details
Address
4294 Lomac Street
Montgomery, AL 36106
Billing Phone
334-274-9000
Specialty Type
Physician Assistant
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