Contract Details
Facility name
Southern Patient Care
Provider ID
P000006683
NPI
1134146830
Tax ID
582004338
Effective Date
10/10/2012
Last Updated
6/6/2016
Direct Contract
Yes
Term Date
2/5/2014
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
77.00
Location Details
Address
2776 East Gunter Park Drive Unit L
Montgomery, AL 36109
United States
County
Montgomery
Phone
8888804772 (Phone)
Billing Details
Address
2776 East Gunter Park Drive
Unit L
Montgomery, AL 36109
Billing Phone
8888804772
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address