Stephen    Blackstock    MD
Contract Details
Northeast Orthopedic Clinic
Facility name
Provider ID
P000000001
NPI
1356373583
Tax ID
631081989
Effective Date
10/15/1999
Last Updated
6/24/2022
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
507 South 4th Street
Gadsden, AL 35901
United States
Phone
256-547-7417 (Phone)
Billing Details
Address
507 South 4th Street
Gadsden, AL 35901
Billing Phone
256-547-7417
Specialty Type
Surgery, Orthopedic
Website
Visit Website
Map
Address