Mark    Ellis    MD
Contract Details
Dale Medical Center
Facility name
Provider ID
P000000001
NPI
1083632244
Tax ID
636001875
Effective Date
12/23/2016
Last Updated
3/14/2024
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
M
Exhibit ID
AM_291
Location Details
Address
359 James Street
Ozark, AL 36360
United States
Phone
334-443-0270 (Phone)
Billing Details
Address
359 James Street
Ozark, AL 36360
Billing Phone
334-443-0270
Specialty Type
Family Practice
Map
Address