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Contract Details
PainSouth, Inc.
Facility name
PainSouth
Provider ID
P000009039
NPI
1447210844
Tax ID
631203826
Effective Date
1/5/2018
Last Updated
2/5/2019
Direct Contract
Yes
Term Date
2/5/2019
Status
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
2700 10th Avenue South Suite 444
Birmingham, AL 35205
United States
County
Jefferson
Phone
2052979801
(
Phone
)
Billing Details
Address
2700 10th Avenue South
Suite 444
Birmingham, AL 35205
Billing Phone
2052979801
Specialty Type
Pain Management Facility - Procedures Only
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Address