John    Durant    MD
Contract Details
Ivy Creek Health
Facility name
Provider ID
P000000001
NPI
1790717858
Tax ID
631282722
Effective Date
7/7/2022
Last Updated
7/8/2022
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
82.00
Location Details
Address
301 Mariarden Road Suite D
Dadeville, AL 36853
United States
Phone
256-826-7871 (Phone)
Billing Details
Address
301 Mariarden Road
Suite D
Dadeville, AL 36853
Billing Phone
256-825-7871
Specialty Type
General Practice
Website
Visit Website
Map
Address