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Contract Details
BW Physician Practices, LLC
Facility name
Brookwood Occupational Health Clinic
Provider ID
P000006787
NPI
1528341906
Tax ID
474758110
Effective Date
10/3/2015
Last Updated
9/28/2015
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
4760 Eastern Valley Road Suite 102
Mc Calla, AL 35111
United States
County
Tuscaloosa
Phone
2059698818
(
Phone
)
Billing Details
Address
4902 Valleydale Road
Birmingham, AL 35242
Billing Phone
2059698818
Specialty Type
Occupational Medicine Facility
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Address