Marcial    Mendez    MD
Contract Details
Ivy Creek Health
Facility name
Provider ID
P000000001
NPI
1407870504
Tax ID
631253446
Effective Date
7/7/2022
Last Updated
7/15/2022
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
82.00
Location Details
Address
2256 Gilmer Avenue
Tallassee, AL 36078
United States
Phone
334-283-2542 (Phone)
Billing Details
Address
2256 Gilmer Avenue
Tallassee, AL 36078
Billing Phone
334-283-2542
Specialty Type
Family Practice
Website
Visit Website
Map
Address