Contract Details
Facility name
Surgical Clinic
Provider ID
P000008009
NPI
1295762540
Tax ID
630653394
Effective Date
8/1/2014
Last Updated
1/7/2015
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
90.00
Location Details
Address
121 North 20th Street Building 3
Opelika, AL 36801
United States
County
Lee
Phone
3347456271 (Phone)
Billing Details
Address
121 North 20th Street
Building 3
Opelika, AL 36801
Billing Phone
3347456271
Specialty Type
Surgery, General
Map
Address