Contract Details
PMCOA, Inc.
Facility name
Pain Management Center of Montgomery
Provider ID
P000008209
NPI
1861750267
Tax ID
455119160
Effective Date
3/13/2015
Last Updated
10/25/2016
Direct Contract
Yes
Term Date
10/1/2016
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
90.00
Location Details
Address
3283 Malcolm Drive
Montgomery, AL 36116
United States
County
Montgomery
Phone
3343561111 (Phone)
Billing Details
Address
P.O. Box 241467
Montgomery, AL 36124
Billing Phone
3343561111
Specialty Type
Pain Management Facility
Map
Address