Healthcare Provider Details

I. General information

NPI: 1003436254
Provider Name (Legal Business Name): DIRECT PAY PROVIDER NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 CORPORATE DR STE 200
BIRMINGHAM AL
35242-2733
US

IV. Provider business mailing address

PO BOX 381866
BIRMINGHAM AL
35238-1866
US

V. Phone/Fax

Practice location:
  • Phone: 866-214-5920
  • Fax: 844-325-6485
Mailing address:
  • Phone: 866-214-5920
  • Fax: 844-325-6485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: JASON WASHAM
Title or Position: PROVIDER NETWORK MANAGER
Credential:
Phone: 205-397-3096