Contract Details
Jackson Hospital and Clinic, Inc.
Facility name
Jackson Clinic
Provider ID
P000008305
NPI
1023317666
Tax ID
636001820
Effective Date
2/1/1998
Last Updated
7/13/2015
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
90.00
Location Details
Address
1801 Pine Street Suite 103
Montgomery, AL 36106
United States
County
Montgomery
Phone
3342938888 (Phone)
Billing Details
Address
1801 Pine Street
Suite 103
Montgomery, AL 36106
Billing Phone
3342938888
Specialty Type
Family Practice
Map
Address