Contract Details
Fast360, LLC
Facility name
Southern Neurology
Provider ID
P000007461
NPI
1679554620
Tax ID
460926698
Effective Date
1/1/2017
Last Updated
5/21/2017
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
M
Exhibit ID
AM_312
Location Details
Address
2018 Brookwood Medical Center Drive Suite 202
Birmingham, AL 35209
United States
County
Jefferson
Phone
8666746728 (Phone)
Billing Details
Address
761 Old Hickory Boulevard
Suite 300
Brentwood, TN 37027
Billing Phone
8666746728
Specialty Type
Diagnostic Services
Map
Address