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Contract Details
Facility name
Fagan Sports Medicine
Provider ID
P000007216
NPI
1770740482
Tax ID
631245249
Effective Date
7/5/2000
Last Updated
5/10/2013
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
3125 Independence Drive Suite 300-A
Birmingham, AL 35209
United States
County
Jefferson
Phone
2058798206
(
Phone
)
Billing Details
Address
3125 Independence Drive
Suite 300-A
Birmingham, AL 35209
Billing Phone
2058798206
Specialty Type
Sports Medicine
Map
Address