Provider Demographics
NPI:1558325712
Name:BHC - COMPREHENSIVE WOUND CARE CLINIC AT PRINCETON
Entity Type:Organization
Organization Name:BHC - COMPREHENSIVE WOUND CARE CLINIC AT PRINCETON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VALETA
Authorized Official - Middle Name:D
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-715-5901
Mailing Address - Street 1:833 PRINCETON AVE SW
Mailing Address - Street 2:POB III; SUITE 210
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1323
Mailing Address - Country:US
Mailing Address - Phone:205-783-3740
Mailing Address - Fax:205-783-3739
Practice Address - Street 1:833 PRINCETON AVE SW
Practice Address - Street 2:POB III; SUITE 210
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1323
Practice Address - Country:US
Practice Address - Phone:205-783-3740
Practice Address - Fax:205-783-3739
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST HEALTH CENTERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-14
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529912980Medicaid
AL529912980Medicaid
ALJ721Medicare PIN