Contract Details
Facility name
Cullman Primary Care
Provider ID
P000002603
NPI
1598717381
Tax ID
631165851
Effective Date
9/28/2011
Last Updated
6/9/2016
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
503 Clark Street Northeast
Cullman, AL 35055
United States
County
Cullman
Phone
2567394131 (Phone)
Billing Details
Address
503 Clark Street Northeast
Cullman, AL 35055
Billing Phone
2567394131
Specialty Type
Family Practice
Map
Address