Contract Details
Facility name
Southern Patient Care
Provider ID
P000006684
NPI
1588683270
Tax ID
582004338
Effective Date
10/10/2012
Last Updated
3/4/2022
Direct Contract
Yes
Term Date
2/28/2022
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
77.00
Location Details
Address
1523 Cliff Gookin Boulevard
Tupelo, MS 38801
United States
County
Lee
Phone
6626804343 (Phone)
Billing Details
Address
1523 Cliff Gookin Boulevard
Tupelo, MS 38801
Billing Phone
6626804343
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address