Tanya    Theriault    DO
Contract Details
Jay Hospital
Facility name
Provider ID
P000000001
NPI
1093919284
Tax ID
592425149
Effective Date
9/11/2024
Last Updated
9/12/2024
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
M
Exhibit ID
AM_241
Location Details
Address
14114 Alabama Street
Jay, FL 32565
United States
Phone
850-675-8000 (Phone)
Billing Details
Address
14114 Alabama Street
Jay, FL 32565
Billing Phone
Specialty Type
Psychiatry
Map
Address