Contract Details
Infirmary Medical Clinics
Facility name
IMC Diagnostic and Medical Clinic
Provider ID
P000008232
NPI
1447201066
Tax ID
631012832
Effective Date
10/30/1992
Last Updated
11/7/2022
Direct Contract
Yes
Term Date
10/6/2022
Status
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
297 A South Jackson Street
Grove Hill, AL 36451
United States
County
Clarke
Phone
2514351200 (Phone)
Billing Details
Address
297 A South Jackson Street
Grove Hill, AL 36451
Billing Phone
2514351200
Specialty Type
Family Practice
Map
Address