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Contract Details
Facility name
Metro Infectious Disease Consultants
Provider ID
P000008045
NPI
1659702223
Tax ID
363966745
Effective Date
5/22/2014
Last Updated
12/8/2014
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
F
Fee Schedule Name
107.00
Fee Schedule Multiplier
Location Details
Address
1102 Monroe Street Southwest
Huntsville, AL 35801
United States
County
Madison
Phone
2564697200
(
Phone
)
Billing Details
Address
901 McClintock Drive
Suite 202
Burr Ridge, IL 60527
Billing Phone
8882206432
Specialty Type
Infectious Diseases
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