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Contract Details
Surgical Specialists of Alabama
Facility name
Southeast Physician Network
Provider ID
P000008923
NPI
1598090839
Tax ID
270996600
Effective Date
8/16/2017
Last Updated
8/23/2017
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
F
Fee Schedule Name
106.00
Fee Schedule Multiplier
Location Details
Address
1031 Fairfax Park
Tuscaloosa, AL 35406
United States
County
Tuscaloosa
Phone
2053452211
(
Phone
)
Billing Details
Address
P.O. Box 830525
Birmingham, AL 35283
Billing Phone
2053452211
Specialty Type
Surgery, General
Map
Address