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Maria
E
Bennett
MD
Contract Details
Parkwest Family Medical
Facility name
Provider ID
P000000121
NPI
1053375816
Tax ID
237303127
Effective Date
9/8/1994
Last Updated
6/10/2016
Direct Contract
Yes
Term Date
9/16/2013
Status
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
1179 Greenmor Drive
Bessemer, AL 35022
United States
County
Jefferson
Phone
2054818530
(
Phone
)
Billing Details
Address
P.O. Box 11407
Drawer 473
Birmingham, AL 35246
Specialty Type
Family Practice
Map
Address