Provider Demographics
NPI:1003436254
Name:DIRECT PAY PROVIDER NETWORK LLC
Entity Type:Organization
Organization Name:DIRECT PAY PROVIDER NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER NETWORK MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-397-3096
Mailing Address - Street 1:PO BOX 381866
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35238-1866
Mailing Address - Country:US
Mailing Address - Phone:866-214-5920
Mailing Address - Fax:844-325-6485
Practice Address - Street 1:2700 CORPORATE DR STE 200
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-2733
Practice Address - Country:US
Practice Address - Phone:866-214-5920
Practice Address - Fax:844-325-6485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty