Contract Details
Facility name
OrthoSports Associates - St. Vincent's East
Provider ID
P000003462
NPI
1114226438
Tax ID
275501752
Effective Date
5/16/2012
Last Updated
1/5/2023
Direct Contract
Yes
Term Date
12/12/2022
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
48 Medical Park Drive East Suite 255
Birmingham, AL 35235
United States
County
Jefferson
Phone
2058383090 (Phone)
Billing Details
Address
48 Medical Park Drive East
Suite 255
Birmingham, AL 35235
Billing Phone
2059390447
Specialty Type
Sports Medicine
Map
Address