Tara    Randalls    NP
Contract Details
Metro Infectious Disease Consultants
Facility name
Provider ID
P000000001
NPI
1427686062
Tax ID
363966745
Effective Date
3/16/2023
Last Updated
10/30/2023
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
F
Fee Schedule Name
107.00
Fee Schedule Multiplier
Location Details
Address
20 Hughes Road Suite 103
Madison, AL 35758
United States
Phone
888-220-6432 (Phone)
Billing Details
Address
20 Hughes Road
Suite 103
Burr Ridge, IL 35758
Billing Phone
630-655-6748
Specialty Type
Nurse Practitioner
Map
Address