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Edgar
Rojas
PA-C
Contract Details
Alabama Back Institute
Facility name
Provider ID
P000000001
NPI
1780306365
Tax ID
922164113
Effective Date
4/1/2023
Last Updated
7/11/2024
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
87 19th Street W Suite 300
Jasper, AL 35501
United States
Phone
205-221-3606
(
Phone
)
Billing Details
Address
87 19th Street W
Suite 300
Jasper, AL 35501
Billing Phone
205-221-3606
Specialty Type
Physician Assistant
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Address