Contract Details
Facility name
Enterprise Clinic, LLC
Provider ID
P000000001
NPI
1639491616
Tax ID
271826294
Effective Date
4/20/2015
Last Updated
3/23/2021
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
F
Fee Schedule Name
106.00
Fee Schedule Multiplier
Location Details
Address
169 North 2nd Avenue
Hartford, AL 36344
United States
Phone
334-348-8818 (Phone)
Billing Details
Address
169 North 2nd Avenue
Hartford, AL 36344
Billing Phone
334-348-8818
Specialty Type
Family Practice
Map
Address