Lee    Wagner    MD
Contract Details
USA Health Community Providers
Facility name
Provider ID
P000000001
NPI
1316442361
Tax ID
931371454
Effective Date
9/21/2023
Last Updated
10/13/2023
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
19140 South 3rd Street
Mobile, AL 36522
United States
Phone
251-866-0086 (Phone)
Billing Details
Address
19140 South 3rd Street
Citronelle, AL 36522
Billing Phone
251-866-0086
Specialty Type
Family Practice
Map
Address