Pallavi    Sunkavalli    MD
Contract Details
BHC Shelby Internal Medicine
Facility name
Provider ID
P000001692
NPI
1184878639
Tax ID
631161045
Effective Date
1/1/1996
Last Updated
2/9/2015
Direct Contract
Yes
Term Date
11/14/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
636 2nd Street Northeast Suite B
Alabaster, AL 35007
United States
County
Shelby
Phone
2056635770 (Phone)
Billing Details
Address
P.O. Box 830605
Birmingham, AL 35283
Billing Phone
2056635770
Specialty Type
Internal Medicine
Map
Address