Contract Details
Fast360, LLC
Facility name
Southern Orthopedic & Sports Medicine Associates
Provider ID
P000002429
NPI
1184647323
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
2950 Highway 78 East
Jasper, AL 35501
United States
County
Walker
Phone
8666746728 (Phone)
Billing Details
Address
761 Old Hickory Boulevard
Suite 300
Brentwood, TN 37027
Billing Phone
8666746728
Specialty Type
Diagnostic Services
Map
Address