Contract Details
Professional Resource Management of Wiregrass
Facility name
Prime Med
Provider ID
P000009456
NPI
1033495221
Tax ID
202533369
Effective Date
11/27/2019
Last Updated
11/27/2019
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
1970 Andrew Avenue
Ozark, AL 36360
United States
County
Dale
Phone
3347741555 (Phone)
Billing Details
Address
1970 Andrew Avenue
Ozark, AL 36360
Billing Phone
3347741555
Specialty Type
Psychiatry
Map
Address