Alicia    Vasquez    NP
Contract Details
Metro Infectious Disease
Facility name
Provider ID
P000000001
NPI
1417454877
Tax ID
363966745
Effective Date
2/16/2023
Last Updated
2/17/2023
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
F
Fee Schedule Name
107.00
Fee Schedule Multiplier
Location Details
Address
1102 Monroe Street Southwest
Huntsville, AL 35801
United States
Phone
256-469-7200 (Phone)
Billing Details
Address
901 McClintock Drive
Suite 202
Burr Ridge, IL 60527
Billing Phone
888-220-6432
Specialty Type
Nurse Practitioner
Map
Address