Walter  W  Wilson    MD
Contract Details
BHC Pinson Valley Family Care
Facility name
Provider ID
P000001888
NPI
1821184334
Tax ID
631145040
Effective Date
1/1/1996
Last Updated
11/21/2011
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
4360 Main St
Pinson, AL 35126
United States
County
Jefferson
Phone
2056804836 (Phone)
Billing Details
Address
Specialty Type
Family Practice
Map
Address