W.A.    Keith    DO
Contract Details
Baptist Primary Care Forestdale
Facility name
Provider ID
P000000880
NPI
1285747014
Tax ID
631120200
Effective Date
1/1/1996
Last Updated
2/4/2015
Direct Contract
Yes
Term Date
2/4/2015
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
1480 Forestdale Boulevard
Birmingham, AL 35214
United States
County
Jefferson
Phone
2058209050 (Phone)
Billing Details
Address
P.O. Box 830605
Birmingham, AL 35283
Billing Phone
2058209050
Specialty Type
Family Practice
Map
Address