Leah    Holden    NP
Contract Details
Metro Infectious Disease
Facility name
Provider ID
P000000001
NPI
1134539257
Tax ID
363966745
Effective Date
11/15/2022
Last Updated
11/16/2022
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
F
Fee Schedule Name
107.00
Fee Schedule Multiplier
Location Details
Address
123 Ana Drive
Florence, AL 35630
United States
Phone
888-220-6432 (Phone)
Billing Details
Address
901 McClinktock Drive
Suite 202
Burr Ridge, IL 60527
Billing Phone
888-220-6432
Specialty Type
Nurse Practitioner
Map
Address