Bryan    Wimbish    NP
Contract Details
Facility name
Provider ID
P000000001
NPI
1891203873
Tax ID
844617903
Effective Date
8/31/2020
Last Updated
9/11/2020
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
1031 Brocks Gap Parkway Suite 185
Hoover, AL 35244
United States
Phone
205-541-2252 (Phone)
Billing Details
Address
1031 Brocks Gap Parkway
Suite 185
Hoover, AL 35244
Billing Phone
205-541-2252
Specialty Type
Surgery, Orthopedic
Map
Address